2011
Community
B e n e f i t
2011
Plan and Report
Our Promise to the Community
Making a positive measurable difference in the health of
individuals in the communities we serve ... fulfilling the
Scripps mission.
L E T T E R F RO M
THE CEO
Scripps Health was born of commitment to the community more than 85 years ago.
Ellen Browning Scripps and Mother Mary Michael Cummings were both women ahead of their time.
Together, their dedication to the health of the San Diego community created the fabric of Scripps.
Miss Ellen, as she was known, preferred the term “investment” over “donation,” and her contributions
were carefully considered as much for their future promise as for their immediate impact. Decades earlier,
Mother Mary Michael’s patient logs illustrated her fundamental mission to make quality health care
available to all who needed it.
Today, more than 16,000 employees, physicians, and volunteers continue to build on our rich history and
keep the spirit of community service alive. The pages that follow provide a comprehensive account of
how we achieve that: our community benefit programs and services, and our plans for continued action
in the future.
In 2010, Scripps community benefit contributions totaled $337,784,350. This includes $286,232,394
in uncompensated care, $34,845,254 in professional education and health research, $690,103 in
community building activities and $16,016,598 in community health services.
In 2011, we will experience the first effects of health care reform, including reimbursement reductions.
In addition, the community continues to feel the impact of a severe two-year economic downturn that
resulted in high levels of sustained unemployment, significantly reducing the number of insured patients
and increasing the financial burden on health care providers.
In response to the challenges of increasing demand and falling reimbursement, we are currently
undertaking one of the most ambitious projects in our system’s history. Under a new system of horizontal
co-management, similar services – like laboratory and pharmacy services, diagnostic and interventional
radiology, and cardiac and women’s services – will be standardized across the entire system to eliminate
waste, reduce costs, minimize variability, and ensure that we follow evidence-based best practices on all
five hospital campuses and 22 clinic sites.
We remain committed to meeting the health care needs of individuals in our community, regardless of
ability to pay. Moving into the future as a private, nonprofit health care system that makes a vital and
measurable difference in the health of the San Diego community, Scripps will continue to fulfill our
mission adopted more than 80 years ago.
Chris Van Gorder, FACHE
President and CEO
O ur Missio n
Scripps strives to provide superior health services in a caring environment and
to make a positive, measurable difference in the health of individuals in the
communities we serve. We devote our resources to delivering quality, safe, cost
effective, socially responsible health care services. We advance clinical research,
community health education, education of physicians and health care professionals
and sponsor graduate medical education. We collaborate with others to deliver the
continuum of care that improves the health of our community.
O ur Valu e s
We provide the highest quality of service
Scripps is committed to putting the patient first and quality is our passion. In the
new world of health care, we want to anticipate the cause of illness and encourage
healthy behavior for all that rely on us for service. We teach and encourage patients
to participate in their care and to make well-informed decisions. We will be their
advocates when they are most vulnerable. We measure our success by our patients’
satisfaction, their return to health and well being, and our compassionate care for
dying patients, their families and friends.
We demonstrate complete respect for the rights of every individual
Scripps honors the dignity of all persons. We show this by our actions toward one
another and those we serve. We embrace the diversity that allows us to draw on
the talents of one another. We respect and honor the cultural, ethnic and religious
beliefs and practices of our patients in a manner consistent with the highest
standard of care. All this is done in a compassionate setting. Our goal is to create
a healing environment in partnership with all caregivers committed to serving
our patients.
We care for our patients every day in a responsible and efficient manner
Scripps serves as a major community health care resource for San Diego County
and, as such, we are accountable for the human, financial and ecological resources
entrusted to our care as we promote healing and wholeness. We begin from a
base of excellence and collaborate with co-workers, physicians, patients, and other
providers to find new and creative ways to improve the delivery of health care
services. All members of our community will have access to timely, affordable and
appropriate care.
O ur Visio n
Scripps Health will be the premier health care system recognized for delivering
compassionate, unparalleled patient care through clinical quality, advanced
technology, research and innovation.
ii
A BOUT SCRIP P S
Founded in 1924 by philanthropist Ellen Browning Scripps, Scripps Health is a
$2.3 billion nonprofit integrated health system based in San Diego, California.
Scripps treats a half-million patients annually through the dedication of 2,600
affiliated physicians and 13,000 employees among its five acute-care hospital
campuses, home health care services, and an ambulatory care network of physician
offices and 22 outpatient centers and clinics. Scripps has been recognized by
Thomson Reuters as one of the Top 10 health systems in the nation for quality
care. Scripps is also at the forefront of clinical research, genomic medicine, wireless
health and graduate medical education. W ith three highly respected graduate
medical education programs, Scripps is a longstanding member of the Association
of American Medical Colleges.
Scr i pp s Facilitie s Org a n i z a ti o n a l
Include : Fo u n da ti o n
Scripps Green Hospital Scripps provides a comprehensive
Scripps Memorial Hospital Encinitas range of inpatient and ambulatory
Scripps Memorial Hospital La Jolla services through our system of hospitals
Scripps Mercy Hospital and clinics. In addition, Scripps
San Diego Campus participates in dozens of partnerships
Chula Vista Campus with government and not-for-profit
Scripps Clinic (10 locations) agencies across our region to improve
Scripps Coastal Medical Center (12 locations) our community’s health. And our
Scripps Home Health Care partnerships don’t stop at our local
Scripps Whittier Diabetes Institute borders. Our participation at the state,
Scripps Clinical Research Services national, and international levels
includes work with government and
private disaster preparedness and relief
Gover n an ce agencies, the State Commission on
Emergency Medical Services, national
As a not-for-profit health care system,
health advocacy organizations, and even
Scripps takes pride in its service to
international partnerships for physician
the community. The Scripps system is
education and training and direct
governed by a 14-member, volunteer
patient care. In all that we do, we are
Board of Trustees. This single point
committed to quality patient outcomes,
of authority for organizational policy
service excellence, operating efficiency,
ensures a unified approach to serving
caring for those who need us today, and
patients across the region. The
planning for those who may need us in
organizational structure of Scripps
the future.
Health is included in Appendix C.
iii
2 0 11 Scr ipps H e a l th Bo a rd o f Tr u s te e s
Chairman Vice Chair
Robert Tjosvold, Maureen A. Stapleton
Market President General Manager
Bank of America, Retired San Diego County Water Authority
Mary Jo Anderson, CHS Katherine A. Lauer
Health Care Executive, Retired Partner, Latham & Watkins LLP
Richard C. Bigelow Martin J. Levin
Chief Operating Officer Broadcast Journalist, Retired
Luce Forward Hamilton & Scripps LLP
Maureen A. Stapleton
Douglas A. Bingham, Esq. General Manager
Executive Vice President, COO San Diego County Water Authority
The Scripps Research Institute
Robert Tjosvold
Judy Churchill, PhD Market President
Clinical Psychologist, Retired Bank of America, Retired
Gordon R. Clark Chris D. Van Gorder
Board Chairman President and CEO
Access Information Management Scripps Health
Martin C. Dickinson Abby Silverman Weiss
Banker, Retired Mediator/Arbitrator,
Dispute Resolutions
Virginia Gillis, RSM, EdD Partner
Health Care Executive, Retired Baker & McKenzie, LLP, Retired
Report submitted to the Office of Statewide Health Planning and Development (OSHPD) May 2011 in accordance with SB697.
Copyright © Scripps Health, May 2011
iv
2011
2011
C o m m u n i t y
B e n e f i t
OUR PROMISE TO THE COMMUNITY
Scripps Health provided
$338 MILLION in community benefit services in FY10
A History of Service
In 1924, Ellen Browning Scripps founded Scripps Memorial Hospital in the heart
of the sleepy seaside village of La Jolla. That same year, the hospital founded by
Mother Michael Cummings and the Sisters of Mercy in 1890 became Mercy Hospital,
and moved to its current location in Hillcrest.
Through the following decades, those two institutions founded by extraordinary,
visionary women grew along with the region, caring for all those in need — regardless
of ability to pay.
A Mission of Caring A Far-Reaching Network
Serving others has always been at the heart of Scripps’ mission. Today, Scripps Health is recognized as one of the
We were born of commitment to the San Diego community best in the nation, with four hospitals on five
and remain dedicated to delivering quality health care to all campuses, along with a robust network of clinics,
who need it. outpatient, home health and ancillary services to
serve our San Diego community and beyond.
v
We recognize that improving the
community’s health happens both within
and outside the physical walls of our
health care facilities. It also takes place
in shelters, classrooms, and events held
across the community:
• In playgroups and parent
support events organized by
The Parent Connection
• Our 40-foot mobile medical unit,
supplemented screenings and
Our Promise to the Community education at more than 200 local
From nursing to housekeeping, from physicians to accountants, events and health fairs, serving more
every Scripps employee is dedicated to delivering and than 20,000 people in fiscal 2010
supporting quality health care. We are also working hard to • In centers teaching healthy habits
maintain and improve our financial stability, which enables us to to members of at-risk immigrant
care for those who cannot care for themselves. communities
• In underserved neighborhoods,
As the San Diego region continued to feel the effects of a
providing education, screening,
two-year recession in FY2010, including unemployment
diagnostic and treatment services
rates that resulted in fewer patients covered under employer-
where they are needed most
provided health care plans, Scripps began a historic integration
that will enable us to deliver quality care more efficiently, rising
to the unique economic challenges of our times. Scripps Facts
• Scripps treats a half-million patients
We are dedicated to remaining at the forefront of medical annually through the dedication of
innovations, growth and breakthroughs, with a far-reaching 2,600 affiliated physicians and
plan that includes current and future investments in our ability 13,000 employees.
to provide care:
• The integrated Scripps health care
• Emergency department expansions and process
system comprises five acute-care
improvements in all areas to dramatically shorten intervals
hospital campuses, home health care
between arrival and treatment
services, an ambulatory care network
• The first announced advanced proton therapy center for of physician offices, 22 outpatient
San Diego County cancer patients centers and clinics, and a mobile
medical unit.
• Expansions underway at our Scripps Mercy San Diego,
La Jolla, and Encinitas hospital campuses, ensuring that • Among numerous awards and
we will serve the community for years to come recognition, Scripps was recognized
in 2010 as one of the Top 10 health
Our promise is always to be here — for every patient, systems in the nation for quality care
and their children, and their children’s children. by Thompson Reuters.
• With three highly respected graduate
With a rich history and legacy of commitment to the
medical education programs and a
community and a vision for the future that will place us at
new system-wide pharmacy residency
the forefront of innovation, education, research and growth,
program, Scripps is training physicians
Scripps is dedicated to transforming the way health care is
to deliver clinically excellent care in a
delivered, keeping the patient at the center of all we do.
culturally sensitive environment.
Ensuring Access to Health Services
The economic downturn that began in 2009
is changing patterns of health care utilization.
A long-term spike in unemployment and
corresponding loss of health insurance leads
people to postpone needed health care.
Currently, the U.S. Census Bureau estimates
that 22 percent of San Diego county residents
under the age of 65 are uninsured, and
unemployment is at its highest level in a
decade, at 10.1 percent.
Scripps provided $286,232,394 in
uncompensated health care in 2010.
Of this, Scripps Mercy Hospital (including
San Diego and Chula Vista campuses)
provided 69 percent of the charity care
from within the Scripps system. Summary of Benefits
During FY 2010, Scripps provided a total of $337,784,50 in community
benefits, effectively doubling our contribution since 2005.
Total Community Benefits $337,784,350 in FY10
Medicare Shortfalls ............................................ $169,100,309
Community Health Improvement Services
and Community Benefit Operations ................... $6,490,773
Subsidized Health Services ................................. $8,806,307
Cash and in-kind Contributions.......................... $719,518
Community Building Activities............................ $690,103
Professional Education ....................................... $15,950,754
Health Research ................................................. $18,894,500
Charity Care ...................................................... $43,419,911
Bad Debt ........................................................... $14,689,084
Medi-Cal and Other Means-tested
Government Programs ....................................... $59,023,090
*Colors coordinate clockwise from Medicare and Medicare HMO (Shortfalls)
16% of our total operating expenses
in 2010 were devoted to community benefit services at cost.
Health Education
Recognizing that personal behaviors play a significant
role in health and wellness, Scripps is committed to
providing high quality education, prevention and
wellness programs to the community.
We host and participate in education classes,
health fairs, and screening events each year.
From monthly events on our hospital campuses
to special community-based screening events,
and health care support services, we support and
empower community members to care for their
own health and that of their families.
Covering a wide array of programs including
a mobile medical unit, vaccination clinics, Through classes offered at low or no cost to members of the community, Scripps Health helps
patients understand the risks, behaviors, treatment options, and management of a wide array of
early cancer detection, cardiovascular disease illness and disease.
awareness, smoking cessation, diabetes education
and prostate health education, Scripps touched a half-million people in 2010.
Assessing and Meeting Community Needs
Scripps collaborates with other health systems, community
groups, government agencies, businesses and grassroots
organizations to determine priorities for our investments in
community benefit. We are an official partner in Community
Health Improvement Partners (CHIP), a coalition of
25 community health-related organizations that jointly
assess the region’s health needs. Overall, 72 community
leaders collaborated to set priorities for the coming year.
“Charting the Course VI,” CHIP’s 2010 Health Needs
Assessment, identified programs and interventions that are
most critically needed at this time. These guiding principles
shape our strategic approach to creating, extending, and
delivering community benefit programs and activities:
• Access to health services
• Social determinants of health
• Weight status and physical activity
• Injury and violence
• Mental health
Scripps provides diabetes care and education through Project Dulce.
Diabetes Care
The Scripps Whittier Diabetes Institute is dedicated to
caring for and educating people with diabetes through
diabetes management and support programs, including
programs specifically designed for those with limited
or no ability to pay. Through leading research, Scripps
Whittier strives to find a cure for this chronic disease.
Project Dulce, a Scripps Whittier program,
is nationally recognized for addressing diabetes in
low-income and diverse populations. With an emphasis
on self-management education at community health
centers, free clinics, community centers, churches,
senior housing facilities and other community locations,
Project Dulce deploys health care professionals across
the community to achieve measurable improvements in
the health of their patients. Peer educators help patients
overcome cultural, economic or behavioral
barriers to successfully managing their disease.
Scripps Whittier also provides retinal screenings
to low-income individuals at risk for diabetes.
A free, community-based retinal screening identified this patient’s diabetes-related
The screenings can detect eye problems early and retinopathy, which was so severe that without surgery he would have lost his vision
prevent serious complications and blindness. entirely. The diagnosis and surgery were both provided through charity care.
Learning To Cook For Health in City Heights
Much of Scripps’ outreach with these groups originates at
the City Heights Wellness Center, a community-building
partnership between Scripps Mercy Hospital and Rady
Children’s Hospital.
At the heart of the center is its “teaching kitchen,” a hub
for East African community gatherings and classes. In the
kitchen, cooking demonstrations teach immigrants how to
shop for and prepare nutritious foods as they move away
from traditional diets.
The teaching kitchen at City Heights Wellness Center is the place where new,
healthy habits take shape.
In 2010 the center provided 76 coalition-building meetings,
San Diego is home to the second largest Somali serving 2,900 individuals through classes strategically
community in the United States, and Scripps Health designed to empower all residents of City Heights to adopt
provides support for the estimated 25,000 Somali and or maintain healthy lifestyles.
other East Africans now settled in and around the
community of City Heights.
A Vision of Success
A-Visions, an innovative and nationally recognized
supported work program launched in 2002, empowers
people who live with chronic mental illness to secure
steady work with Scripps to aid in their recovery.
People who choose to participate in the A-Visions
program receive personal, individualized guidance and
support from Kevin Wilson, program lead. Kevin, who
has been with A-Visions since its inception, coaches
program participants and helps them develop a
broad-reaching set of life and job skills. Jerry Gold, PhD,
who started the program says, “The primary goal is to
support each candidate’s recovery, while the
secondary focus builds a strong base of productive
work experience.”
Several A-Visions candidates who initially began
working at Scripps Mercy Hospital as volunteers have
successfully transitioned to paid employment, serving
in a variety of clerical and support service roles.
Kevin Wilson, program lead, provides guidance to A-Visions candidates.
Paid A-Visions candidates typically limit their work to
eight hours per week, which allows them to maintain
eligibility for the disability benefits, medications and ongoing behavioral care that supports their work.
Scripps Recuperative Care Program
In collaboration with the San Diego Rescue Mission, the
Scripps Recuperative Care Program ensures that chronically
homeless patients with ongoing medical issues are
discharged safely.
A nursing case manager and Scripps physician provide
medical oversight, medications, durable medical equipment,
and coordinate payment of a daily fee to the Rescue Mission
to support the patient’s stay in the program.
Seventy-five percent of patients discharged through the
program have gone on to complete drug and behavioral
rehabilitation programs, some securing jobs and housing.
In 2010, there were 8,574 documented homeless people
in our community and that number is expected to grow.
Scripps is doing its part to support the complex support
activities of San Diego’s social support and health care
communities. Scripps provided services, supplies and staff
Scripps employees give patients the support they need to be as independent hours to the Scripps Recuperative Care Program during FY10.
as possible.
Professional Education and Health Research
Mayra Dillion, MD, works with an expectant mother as part of a prenatal care program. Thomas McCarthy, MD, provides care at a
community clinic.
Scripps’ nationally recognized Graduate Medical
In March, 2011, Scripps Health received accreditation
Education programs serve our community in three equally
with commendation as a provider of continuing medical
important ways: Training outstanding physicians who
education by the Accreditation Council for Continuing
will remain in practice in our community; providing Medical Education (ACCME) – placing Scripps among
much-needed medical care to the diverse patient the top 8 percent of providers of continuing medical
population of San Diego County; and developing the education (CME) in the United States.
talent and skills of new leaders in medicine, who together
with Scripps will continue to break new ground in
innovative, compassionate medical care.
Compassionate Care
Giving Back Farther North, in the clinic waiting room at the
Mayra Mendoza Dillon, MD, chief resident of the St. Vincent de Paul Village Family Health Center in
Scripps Family Medicine Residency program for the downtown San Diego, a half-dozen uninsured and
2010-2011 academic year, is a Southern California native homeless patients have checked in, seeking medical
whose parents emigrated to the U.S. from Mexico. care for a variety of health issues and concerns.
Half of the current residents in the program are members Thomas McCarthy, MD, a second-year resident with the
of underrepresented minorities, mostly bilingual and Scripps Green Internal Medicine Residency program,
bicultural Latinos. pulls up a chair beside Maida Soghikian, MD, attending
physician. They briefly discuss the list of scheduled
Dr. Dillion is particularly proud of “Centering Pregnancy,” patients, then check on the first walk-in of the night.
a curriculum she helped launch in 2009. “Prenatal
care, which also includes education for new fathers, is “I’m really swollen in my legs and my fingers, Doctor,”
something we want to start very early in pregnancy,” says, the patient, holding up her hands to demonstrate
says Dr. Dillion. This interactive prenatal education group how painfully tight her ring has become. “I know my
teaches couples about breastfeeding, stress in pregnancy, body. This isn’t normal.” Dr. McCarthy begins asking
diet and exercise, domestic violence, and post-partum a probing series of questions, to get to the root of the
depression, among other topics. young, uninsured mother’s malady.
With a vision for the future,
Scripps is growing to meet the
community’s needs. Expansion efforts
are underway at all our hospitals,
including emergency and critical
services at Scripps Memorial Hospital
Encinitas and Scripps Mercy Hospital.
Scripps is committed to providing
the most advanced, compassionate
care to all who need it, when they
need it most.
Embracing the Challenge
Scripps is proud of our history and the work we do each day. We recognize that access to quality health care, education,
and screening is difficult for many individuals and families in the San Diego region.
Our mission drives us to provide compassionate help and assistance for all who come to us for care, and to reach out
especially to those who find themselves vulnerable and without support.
By responsibly investing in resources, expertise, equipment, medications, and education, Scripps will continue to improve
the lives, health and well being of our community.
Together with our partners, we embrace the central challenge of our mission: To make a positive, measurable difference
in the health of people in the communities we serve.
We are proud of the relationships and resources we have developed in pursuit of this goal, and we know that when we
work together for the benefit of all, there is no limit to what we can do.
Table of Contents
Table of Contents
Table of Contents
Preface CEO Letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Section 1 System Summary: Fulfilling the Scripps Mission . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Section 2 Assessing Community Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Section 3 Uncompensated Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Section 4 Community Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Section 5 Professional Education & Health Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65
Section 6 Scripps Memorial Hospital La Jolla . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70
Section 7 Scripps Memorial Hospital Encinitas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83
Section 8 Scripps Mercy Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
Section 9 Scripps Green Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .118
Section 10 Scripps Whittier Diabetes Institute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126
Section 11 Scripps Medical Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135
Section 12 Scripps System-Wide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141
Section 13 Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .159
System Summary
“independent
We want patients to be as
as possible,
and we give them the
”
System Summary
support they need.
– Rose Turner, RN
Scripps collaborates with partners in the community to help support patients after they are discharged, helping them to make stronger recoveries.
Helping Homeless Patients Stay Off the Streets
For most patients, leaving the hospital means going “We want patients to be as independent as possible,
home to recover in the comfort and safety of their own and we give them the support they need to
beds. But what about those who don’t have beds? achieve that.”
Or, for that matter, homes?
Since its founding, 10 Scripps patients have entered the
A unique collaboration between Scripps Mercy Hospital, Recuperative Care Program.
the San Diego County Hospital Association and the
San Diego Rescue Mission provides homeless patients Gary Knox was initially taken to Scripps Mercy Hospital
who have nowhere to go after a hospital stay by ambulance. It was his third trip to the emergency
continued medical care in a safe, stable environment. department. This time, he was diagnosed with acute
Along with shelter, food, clothing and support services, hepatitis, liver and kidney failure, all resulting from
the Recuperative Care Program helps homeless patients long-term alcohol abuse. His legs were extremely
fully recover and, ideally, escape the streets. swollen and numb, and he leaned on a shopping cart
to walk. After six weeks in the hospital, Gary was
The program began as a pilot in June 2009. discharged into the Recuperative Care Program.
After touring similar programs in Los Angeles, Slowly, he began to turn his life around.
Mary E. Whitehead, Scripps’ administrative director,
system-wide case management, headed up a clinical “Drinking almost killed me. If it wasn’t for Scripps and
team of nurses, case managers, physicians and social the Rescue Mission, I wouldn’t be here today,” says
workers to customize a program for Scripps. Gary. “People here have kept me on the straight and
narrow. I always have the choice to come or go, but the
To qualify, patients who are homeless must require staff has a way of talking sense into you when you get
continuing medical care for an acute illness or injury. discouraged. Everyone wants me to succeed. They have
They also need to be able to perform such daily living picked me up from lower than the gutters and brought
activities as showering, dressing and eating without me back to being a functional civilized person again,
assistance. In the program, patients must get up at a which I never thought would happen.”
certain time, make their beds, go to the dining room for
meals, take their medications as scheduled, make their In 2010, Scripps contributed services, supplies and more
own medical appointments and get to them on time. than 400 hours in staff time to the program.
“If they have a problem with their medications or
transportation, they can call me, or they can let the
Rescue Mission staff know and the staff will contact
me,” says Rose Turner, RN, a Scripps case manager who
works exclusively with the program to ensure a smooth
coordination of care.
Section System Summary
1 Fulfilling the Scripps Mission
This report was developed in response to Senate Bill 697.
Passed in 1994, the bill requires California’s community, Scripps devoted
not-for-profit hospitals to annually describe and document $337,784,350 to
the full range of community benefits they provide. Scripps has
community benefit
taken this legislative requirement a step further.
programs and
This report incorporates not only documentation of community services during
benefits, but also a more detailed explanation of the specific
community benefit activities provided on our five acute-care
Fiscal Year 2010.
hospital campuses, through home health care, our wellness
centers and clinics.
The report details programs and services that provide benefit to the community over and above
standard practices of care, categorized into three primary areas:
• Uncompensated Health Care
• Community Health Services
• Professional Education and Health Research
The report covers the period of Oct. 2009 through Sept. 2010 (Fiscal Year 2010).
During this fiscal year, Scripps devoted $337,784,350 to community benefit programs and services
in the three above areas (see figures 1:1 and 1:2). Our programs emphasize community-based
prevention efforts and use innovative approaches to reach area residents at greatest risk for
health problems.
Definitions of terms used in this report can be found within Appendix A.
The documentation and activities described in this report are commitments we make in order to
improve the health of our patients and our San Diego communities. As a long-standing member
of these communities, and as a not-for-profit community resource, our goal and responsibility are
to provide help and assistance for all who come to us for care, and to reach out especially to those
who find themselves vulnerable and without support. This responsibility is an intrinsic part of our
mission. Through our continued actions and community partnerships, we strive to raise the quality
of life in the community as a whole.
1
Community Benefit is defined as programs or activities that provide treatment or promote health
and healing in response to an identified community need.
Community Benefit programs must meet at least one of the following criteria:
• Respond to a public health need
• Involve education or research that improves overall community health
• Respond to needs of special populations
S
• upply services or programs that would likely be discontinued if the decision was made on a
purely financial basis because they operate at a financial loss.
Schedule H (Form 990)
Hospitals with tax-exempt status are now required to provide information specific to their
organization on the new Schedule H of the recently redesigned Form 990 (the annual information
return filed by tax-exempt organizations). The entire Schedule H is mandatory beginning with tax
year 20091.
Schedule H contains six parts. Part I requests details about a hospital’s charity care program and
quantifies charity care expenditures. Part II quantifies the hospital’s community building activities.
Part III quantifies the cost due to Medicare shortfalls and bad debts owed to the organization.
Part IV requires disclosure of any joint ventures in which a hospital participates. Part V requests
information about the entity’s health care facilities. Part VI provides an area in which to discuss,
in a narrative fashion, other charitable activities that may be difficult to quantify. (See Appendix A
for a definition of terms).
Scripps has aligned its 2011 Community Benefit Plan and Report to the new Schedule H categories.
According to the IRS, community building activities, bad debt and Medicare shortfalls are reported
but not included in the community benefit totals. (See page 19 for a breakdown of Scripps System
Uncompensated Care Summary for FY10).
1 Congressional Research Service, November 19, 2009. www.crsdocuments.com
2
FIGURE 1:1
FY10 Scripps Total Community
Benefit Services Distribution by Category, $337,784,350
Community
Building Activities Medi-Cal and Other
$690,103 Means-tested
0.2% Government
Subsidized Programs
Professional Education Health Services $59,023,090
Community Charity Care
and Health Research $8,806,307 17.5%
Health Services $43,419,911
$34,845,254 2.6%
$7,210,291 12.9%
10.3%
2.1%
Bad Debt
$14,689,084
4.3%
Medicare Shortfalls
$169,100,309
50.1%
Community Benefit Services:
Community benefit services include those programs and services offered to the community that go
above and beyond what is provided as a normal part of patient care. Scripps categorizes community
benefit services in three categories, including uncompensated health care, community health
services, and professional education and health research. Uncompensated care includes charity
care, bad debt, Medi-Cal and Other Means-Tested Government Programs and Medicare shortfalls.
3
FIGURE 1:2
FY10 Scripps Total Community Benefit Services
by Operating Unit, $337,784,350
Scripps Mercy Hospital
Chula Vista
$29,418,673 Scripps Medical Scripps System Wide
8.7% $20,754,577 Scripps Memorial
Foundation
6.1% Hospital La Jolla
$53,771,430
$68,543,423
Scripps Whittier 15.9%
20.3%
Diabetes Institute
$1,025,454
0.3%
Scripps Green Hospital
$36,789,806
Scripps Mercy Hospital
10.9%
San Diego and Mercy Clinic
$86,000,449
25.5% Scripps Memorial Hospital Encinitas
$41,480,539
12.3%
Community Benefit Services:
Community benefit services include those programs and services offered to the community that go
above and beyond what is provided as a normal part of patient care. Scripps categorizes community
benefit services in three categories, including uncompensated health care, community health
services, and professional education and health research. Uncompensated care includes charity
care, bad debt, Medi-Cal and Other Means-Tested Government Programs and Medicare shortfalls.
4
FIGURE 1:3
FY10 Scripps Schedule H Community Benefit Services
by Category, $153,304,854
Medi-Cal and
Other Means-tested
Government Programs
$59,023,090
38.5%
Subsidized Health Services
Community $8,806,307
Health Services and 5.7%
Community
Benefit Operations
$7,210,291
4.7%
Charity Care Professional Education
$43,419,911 and Health Research
28.3% $34,845,254
22.7%
Community Benefit Services (Schedule H):
Community building activities, bad debt, and Medicare shortfall do not count as community
benefits under the new Schedule H 990, but are still reportable outside the community
benefit table.
5
Assessing Community Needs
“ I thought, ‘do you want to sit in a
wheelchair, or take care of yourself
and be healthy?
” – Trinidad Marasigan
Assessing Community Needs
Trinidad Marasigan was uninsured and needed help learning to manage her diabetes.
Learning to be Healthy
When Trinidad Marasigan checked in at Operation I was very scared of taking insulin,” says Trinidad.
Samahan community clinic last April, she was worried “It taught me that these things are not bad. I thought,
to the point of panic – her blood sugar was high, she ‘do you want to sit in a wheelchair, or take care of
suffered dizzy spells, and her weight was ballooning. yourself and be healthy?’”
The 63-year-old uninsured Filipino woman was the The elevated risk for diabetes within the Filipino
perfect candidate for Project Dulce. community is compounded by the present economic
recession and rise in the uninsured.
A partnership between Scripps Health and a network
of 13 community-based clinics, Project Dulce is a “This makes programs like Project Dulce more vital
comprehensive diabetes management program for the than ever,” says Athena Philis-Tsimikas, MD, an
underserved and uninsured in San Diego County. endocrinologist and corporate vice president of
Scripps Whittier Diabetes Institute, which helped launch
The program, which served more than 14,000 people Project Dulce in 1997 and actively tracks about 5,000
in San Diego County through 440 classes last year, Project Dulce diabetes patients at any given time.
is tailored to fit the unique cultural needs of the
population that each clinic serves, such as Operation Project Dulce participants have significant reductions
Samahan’s largely Filipino community in San Diego’s in HbA, blood pressure, and cholesterol, compared to
Mira Mesa neighborhood. diabetes patients who don’t participate in the program,
according to Dr. Tsimikas.
For Trinidad, that meant learning about which familiar
ethnic foods caused her blood glucose to spike. It also While studies indicate that Project Dulce participants
meant learning to cut back on portion sizes, overcoming experience higher up-front costs in the first year of
misconceptions about diabetes medications, and intervention, because they are getting the medications
beginning an exercise regimen. and diabetes testing supplies that they might otherwise
not have gotten, they have also reduced emergency
After completing an eight-week course of intensive room and hospitalization costs.
classes and regular monitoring by the Project Dulce
team, Trinidad’s hemoglobin A1c – which measures what “It’s a unique program,” says Dr. Tsimikas. “We’ve not
a diabetic’s blood sugar levels have been running for the been able to find another one like it in the country
past three months – dropped from 11.4 percent to where community health centers and a nonprofit center
8.7 percent, and she’d shed 20 pounds. of excellence in diabetes work this collaboratively, and
produce these kinds of results.”
“If I didn’t come to the Project Dulce classes, things
would be very different because I didn’t know how to
manage food portions, I didn’t know about exercise, and
Section
2 Assessing Community Needs
California Senate Bill 697 requires the updating of a community health needs assessment at least
every three years. Identifying San Diego County’s health priorities is a complex process outlined in
the following pages.
Scripps strives to improve community health through collaboration. Working with other health
systems, community groups, government agencies, businesses and grassroots movements, we are
better able to build upon existing assets to achieve broad community health goals.
The report reflects the sixth edition of the triennial needs assessment. The project was initially
undertaken by the Hospital Council of San Diego and Imperial Counties in 1995 to assist private
not-for-profit hospitals to comply with state community benefit legislation Senate Bill 697 (SB697),
which required them to conduct a periodic assessment of the health needs of those living in their
service area in order to better respond to the community’s health needs. The group was initially
known as the San Diego County SB697 Coalition and attended by representatives from over
25 health care-related organizations. The goal of the coalition was to collaborate and produce one
needs assessment in order to maximize resources and develop a more comprehensive report for
the County of San Diego. During the five subsequent needs assessments, the coalition, renamed
Community Health Improvement Partners (CHIP) shortly after the completion of the
first assessment, formalized its role to provide oversight and direction to the periodic needs
assessment process.
Community Health Improvement Partners
Scripps is an official partner and an active participant in Community Health Improvement Partners
(CHIP). Through CHIP, more than 25 community health-related organizations come together to
jointly address the county’s health needs. Scripps works with CHIP and other health care systems
and partners to develop a comprehensive county health needs assessment which is updated every
three years, including county, state and national health statistic comparisons. The collaborative
assessment process is one of the most respected in California.
Charting the Course VI: Health Needs Assessment for San Diego County
Charting the Course VI is intended to help fulfill legislative requirements of SB 697 and to provide a
resource for individuals, agencies and institutions to identify community health needs and concerns.
Readers are encouraged to explore Charting the Course VI to learn more about the critical health
issues impacting San Diego County residents. This document presents a wealth of information
6
relating the health issues to race/ethnicity, gender, age category and geographic region.
The report also monitors changes and trends in health status among San Diego County residents.
This information provides the basis upon which community health programs and interventions
can be targeted, developed and evaluated, with the ultimate goal of improving the health of
the community and its members. To gain a full understanding of Scripps’ health assessment and
analysis of community need in San Diego, we recommend reviewing the CHIP 2010 Charting the
Course VI San Diego County Health Needs Assessment at http://www.SDCHIP.org.
2010 Priority Setting Process
One of the major features of each needs assessment is the review of health issues impacting the
San Diego region. These health issues are examined from a local (San Diego County), state and
national perspective. The starting point for this process was a review of the 38 Healthy People
2020 focus areas, a set of science-based, 10-year national objectives for improving the health of all
Americans (http://www.healthypeople.gov).
Because of the large number and the diversity of local health issues, the needs assessment
committee selected 17 health issues for additional study and possible inclusion in this year’s needs
assessment. These issues were selected based on an extensive review of the issues and a ranking of
their perceived importance.
The goal of the priority-setting process was to provide an organized, objective method of
reviewing and prioritizing health issues facing San Diego County. These issues were divided into
three categories:
O
• verarching Issues (4 issues) — issues that potentially impact all of the other issues.
These included:
o Access to health services
o Health communications and health information technology
o Public health infrastructure
o Social determinants of health
H
• ealth-Related Behaviors (6 issues) — behaviors that are important components in long-term
health, such as:
o Immunization
o Smoking cessation
o Improving nutrition
o Increasing physical activity
o Achieving a healthy weight status
o Oral health
o Violence and injury prevention
7
H
• ealth Outcomes (7 issues) — tracking change in the health status of the population and
various demographic groups over time related to:
o Cancer
o Diabetes
o Heart disease and stroke
o Infectious diseases
o Maternal, infant and child health
o Mental health
o Respiratory diseases
To help narrow the number of health issues, 379 community leaders from throughout San Diego
County were invited to prioritize each issue based on the following four criteria:
1. What is the size of the health issue in San Diego County?
2. What is the seriousness of the health issue in San Diego County?
3. What community resources are currently available to address the health issue?
4. How much data or information do we have to evaluate the health issue’s outcomes?
Participants in this priority-setting process were asked to review the information for each health
issue covered in a briefing document, provide their ratings from their perspective and weigh each
issue using the information provided along with their knowledge of the health issue. Overall,
72 community leaders participated in the priority-setting process, ultimately selecting five health
issues for the focus of Charting the Course IV.
• Access to health services
• Social determinants of health
• Weight status and physical activity
• Injury and violence
• Mental health
Charting the Course IV contains an in-depth review of these five health issues, along with the
priority-setting process used to select these issues and the background information related to the
17 additional issues reviewed as part of the priority-setting process. In addition, information is
presented related to the community forums held in each of the six regions of San Diego County to
gain insights into the health issues of weight status, mental health, and injury and violence, and to
begin the process of identifying some of the root causes related to these issues2.
Demographic and community need information data presented throughout the body of this document are based upon
the findings of the 2010 Community Health Needs Assessment or the most recent San Diego County community health
statistics (unless otherwise indicated).
2 Community Health Improvement Partners (CHIP). Charting the Course VI 2010: A San Diego County Health Needs Assessment.
Retrieved from the World Wide Web: http://www.sdchip.org.
8
Access to Health Services
The current economic downturn in the U.S. is believed to be changing patterns of healthcare
utilization resulting in, among other things, people putting off needed healthcare and skipping
dental care due largely to unemployment and lack of insurance coverage.
C
• ities most impacted by high unemployment in San Diego County include National City
(19.7%), Imperial Beach (16.5%), Fallbrook (13.2%), Lemon Grove (13%) and Vista (11.6%).
• Currently, an estimated 23% of San Diego residents under age 64 are uninsured.
C
• ommunity clinics in San Diego County are experiencing a rise in primary care clinic
utilization rates and hospital emergency departments have experienced a sharp rise in
Medi-Cal utilization.
• Latinos and the unemployed are most likely to be without health insurance.
9
Social Determinants of Health
Social determinants of health, including education, economic status, living conditions and cultural
elements, are factors that threaten health, promote health and protect health.
Weight Status, Nutrition and Physical Activity
The long-term health consequences of being overweight or obese are significant.
D
• uring 2009, the prevalence of adults in San Diego County with an unhealthy weight status,
either overweight or obese, was nearly 60%.
• Adults most likely to be obese include African Americans and Latinos.
A
• mong children living in San Diego County, the prevalence of those overweight or obese was
nearly 28% during 2007, the most recent period during which data is available.
• Children most likely to be overweight or obese include African Americans and Latinos.
10
Injury and Violence
Prevention of unintentional injury and death offers a tremendous opportunity to impact the health
of San Diego County residents.
D
• uring 2008, there were 932 deaths and 20,850 hospitalizations resulting from unintentional
injury and 149,900 hospital emergency department discharges following treatment for
unintentional injuries. Moreover, the number of physician office and clinic visits related to
unintentional injury, while unknown, is likely much higher than the number of emergency
department visits.
U
• nintentional injuries are one of the leading causes of death for San Diego County residents
in all age categories regardless of gender, race or region.
B
• etween 2000 and 2008, the rate of death related to unintentional injury increased by
nearly 10%.
T
• hose most impacted by death as a result of unintentional injury are males, persons age
85 or over, American Indians and persons living in the East region.
Unintentional Injury Pyramid 2008 San Diego County
11
Mental Health
Serious mental illness is a leading cause of disability in the U.S.
T
• he estimated prevalence of serious mental illness in San Diego County is 5% of the
population, impacting more than 141,400 persons.
D
• uring 2008, suicide, one of the major complications of depression, was the 8th leading
cause of death in San Diego County.
12
Community Input
Community forums were held in each of the six regions of San Diego County. The six forums were
attended by more than 200 community stakeholders representing a wide variety of programs,
agencies and organizations.
The following table highlights some of the root causes identified by community stakeholders
related to each health issue.
Summary of Identified Root Causes by Health Issue
Weight status, nutrition and
Injury And Violence Mental Health
Physical Activity
L
• imited access to affordable, L
• imited access, knowledge S
• tigma associated with
fresh, healthful foods and awareness of prevention mental illness
L
• imited access to safe • Gang activity C
• ultural beliefs related to
affordable space for physical E
• asy access and use of illicit mental illness
activity drugs and alcohol P
• rovider systems intimidate
S
• ocietal norms do not • Unsafe home environments consumers
support physical activity H
• igh-risk activities among S
• ocioeconomic, cultural and
F
• ast foods are easily youth language barriers to care
accessible, less expensive L
• anguage and cultural issues L
• imited number of culturally
and marketed heavily related to laws and trust in competent psychiatrists
S
• ociety’s encouragement of governmental programs and nurses
sedentary activities M
• ilitary culture conflicts with P
• rimary care physicians
F
• ear of crime and safety civilian code of conduct unwilling to accept referrals
issues related to being C
• ultural bias against services or do screening, assessment
physically active in to seniors and Latinos and brief interventions
neighborhoods and parks C
• ultural norms do not L
• imited knowledge on how
L
• anguage barriers support reporting problems to navigate the mental health
D
• istrust of neighbors, treatment system
community leaders and fear
of retaliation
• Low literacy levels
13
Community Priority Scoring Process Results
By Scoring Criteria and Overall Ranking
* Items within a particular category denote similar scores or ties in scores. No statistical analysis was applied to this tool, it was designed as a
rating tool to assist in the decision making process.
14
San Diego County HHSA Geographic Services Regions
Meeting the Challenges of a Diverse Border Community
San Diego County is an international border community comprised of 3.2 million people.
Geographically dispersed over 4,300 square miles, the population represents multiple ethnic
groups. The San Diego Association of Government’s (SANDAG) population growth projections
are just over 1 percent per year, extending out 25 years to the year 2030. The SANDAG 2050
Sub-regional Growth Forecast projects population growth to 4.4 million by 2050. This is a 40.0%
increase in population growth. Demographic estimates and projections are based on SANDAG
2010 estimates and are available at the zip code level at http://datawarehouse.sandag.org. A
breakdown of the regional demographics can be found in the regional forum sections of the
Charting the Course VI: Health Needs Assessment for San Diego County (Appendix Section)
http://www.SDCHIP.org.
Scripps serves a quarter of the total county population, concentrating services in the North coastal,
North Central, Central and South regions of San Diego County where Scripps facilities are located
(Appendices D and E).
15
FIGURE 2:1
Leading Causes of Death Among
San Diego County Residents
Leading Causes of Death Among San Diego County Residents by
HHSA Regions†, 20083
Number and Percent of Deaths
COUNTY- REGION†
WIDE N. Coastal N. Central Central South East N. Inland
CAUSE OF DEATHb
RANK IN number % number % number % number % number % number %
2008a of deaths of deaths of deaths of deaths of deaths of deaths
1 Diseases of heart 853 27.0 853 24.6 626 23.5 630 24.5 924 25.0 831 22.7
2 Malignant neoplasms 764 24.2 889 25.6 614 23.1 661 25.7 847 23.0 915 25.0
(all cancers)
3 Alzheimer’s disease 191 6.0 214 6.2 87 3.3 105 4.1 255 6.9 287 7.8
4 Cerebrovascular diseases 213 6.7 186 5.4 147 5.5 148 5.7 205 5.6 211 5.8
5 Chronic lower respiratory 174 5.5 169 4.9 127 4.8 120 4.7 237 6.4 214 5.8
diseases
6 Accidents (unintentional 136 4.3 147 4.2 144 5.4 111 4.3 186 5.0 169 4.6
injuries)
7 Diabetes mellitus 76 2.4 80 2.3 107 4.0 104 4.0 108 2.9 95 2.6
8 Intentional self-harm 70 2.2 71 2.0 55 2.1 41 1.6 66 1.8 49 1.3
(suicide)
9 Influenza and pneumonia 56 1.8 63 1.8 64 2.4 46 1.8 48 1.3 58 1.6
10 Chronic liver disease and 41 1.3 54 1.6 62 2.3 56 2.2 69 1.9 47 1.3
cirrhosis
11 Essential (primary) 50 1.6 52 1.5 31 1.2 26 1.0 57 1.5 58 1.6
hypertension and
hypertensive renal disease
12 Parkinson’s disease 41 1.3 48 1.4 27 1.0 16 .6 35 .9 52 1.4
13 Nephritis, nephrotic 21 .7 23 .7 31 1.2 33 1.3 39 1.1 31 .8
syndrome and nephrosis
14 Neoplasms – in situ, 24 .8 28 .8 12 .5 17 .7 17 .5 27 .7
benign, or unk behavior
15 Viral hepatitis 10 .3 9 .3 26 1.0 31 1.2 21 .6 23 .6
All Other Causes 443 14.0 586 16.9 500 18.8 429 16.7 575 15.6 594 16.2
TOTAL DEATHS: 3,163 100.0 3,472 100.0 2,660 100.0 2,574 100.0 3,689 100.0 3,661 100.0
a Rank is based on total number of deaths in each of the National Center for Health Statistics (NCHS) “rankable” categories. The top 15
leading causes of death presented here are based on the county-wide rank among San Diego residents in 2008.
b Cause of death is based on the underlying cause of death reported on death certificates as classified by ICD-10 codes.
†HHSA Regions were created by grouping contiguous zip codes.
Source: California Department of Public Health, Center for Health Statistics, Office of Health Information and Research, Death Statistical
Master Files; SANDAG January 1 population estimates (Original Estimates 2009_Revised 2001-2008)
Prepared by County of San Diego, Health & Human Services Agency, Public Health Services, Epidemiology & Immunizations Services, 4/19/2010
3 Community Health Improvement Partners (CHIP). Charting the Course VI 2010: A San Diego County Health Needs Assessment.
Retrieved from the World Wide Web: http://www.sdchip.org.
16
Uncompensated Care
“ We see a lot of patients here
who have a hard time doing the
things other people sometimes
take for granted.
”
– Maida Soghikian, MD
Uncompensated Care
Thomas McCarthy, MD, checks Nellie Johnston’s pulse at St.Vincent de Paul medical clinic.
Caring For The Most Vulnerable Patients
It’s a Thursday evening in early spring, and the sun is Back in the physician conference room, Dr. Soghikian,
setting over the St. Vincent de Paul Village Family Health who supervises and confers with Dr. McCarthy, says,
Center in downtown San Diego. In the clinic waiting “I’ve been coming here with residents for eight years
room, a half-dozen patients have already checked in, now. We see a lot of patients here who, because of life
here for medical care to address a variety of health issues circumstances, have a hard time doing the things other
and concerns. people sometimes take for granted, like eating healthy
meals, or buying or taking medications they need.”
Thomas McCarthy, MD, a second-year resident with the
Scripps Green Internal Medicine Residency program, The second patient of the evening, Cynthia Chappell,
pulls up a chair beside Maida Soghikian, MD, attending is homeless. Cyndi is here because of a painful skin
physician this evening. They briefly discuss the list of irritation, but has other health challenges as well. In
scheduled patients, then check in on the first walk-in of light of her blood pressure this evening, Drs. McCarthy
the night. and Soghikian strongly suggest both she and her
husband give up smoking the cigarette butts they
Nellie Johnston came in this evening to discuss test collect and re-roll. Dr. McCarthy would also like her to
results from blood tissue samples taken last week. take medication to control hypertension, and leaves the
Dr. McCarthy puts her immediately at ease. “Everything consultation room to check with a clinic nurse about
looks normal,” he says, explaining the complex lab charity prescription options. He returns with good news:
numbers in, concise, easy-to-understand terms. Cyndi’s homeless status makes her eligible to receive the
“Everything came back negative, so that’s great.” medication for free. He tells her to come back in a week
for follow-up testing.
But while they’re in the room together, Nellie brings
up a new concern. “I’m really swollen in my legs and In 2010, Scripps residents and attending physicians
my fingers, Doctor,” she says, holding up her hands to assessed and treated more than 280 of San Diego
demonstrate how painfully tight her ring has become. County’s most vulnerable residents through the
“I know my body. This isn’t normal.” The young resident St. Vincent de Paul night clinic program.
begins asking a whole new round of questions, trying to
get to the root of the problem.
Section
3 Uncompensated Health Care
Scripps contributes significant resources to provide low and no-cost health care services to
populations in need. During FY10, Scripps contributed $286,232,394 in uncompensated health
care including $43,419,909 in charity care, $228,123,400 in Medi-Cal and Other Means-Tested
Government Programs and Medicare shortfall and $14,689,084 in bad debt.
Scripps provides hospital services to one-quarter of the county’s uninsured patient population.
Of this, Scripps Mercy Hospital (including the San Diego and Chula Vista campuses) provides
69 percent of the charity care from within the Scripps system (refer to figure 3:4).
County Overview
According to a 2006 San Diego County Healthcare Safety Net Study, nearly one-third of
San Diego County’s population (909,661) was uninsured or underinsured at the time, with the
highest concentration – half of the total – south of interstate 8. The hospitals and community clinics
that provide health care to this population are the safety net.
The health care safety net in San Diego County is highly dependent upon hospitals and community
health clinics to provide care to uninsured and medically underserved populations. Finding more
effective ways to coordinate and enhance the current safety net is a critical policy challenge.
While public subsidies (e.g., County Medical Services) help finance services for San Diego County’s
uninsured populations, these subsidies do not cover the full cost of care. Scripps and other local
hospitals are left to absorb the cost involved in caring for the uninsured in their operating budgets,
combined with Medi-Cal and Medicare funding shortfalls. The financial burden placed on hospitals
and physicians to care for uninsured patients is significant.
17
San Diego has experienced a brief improvement in the number of insured residents from
2003 to 2009 (refer to figure 3:1). At that time, 17.2 percent of the adult (19 to 64 and
non-military) population in San Diego County lacks health insurance coverage.
Figure 3:1
Percent of Adults (age 19 to 64 and Non-Military) With Health Insurance Coverage
100.00%
18.10% 18.70% 17.80% 17.50% 17.20%
80.00%
60.00%
40.00% 81.90% 81.30% 82.20% 82.50% 82.80%
Percent Uninsured
Percent Insured
San Diego County, 2001–20094
20.00%
0.00%
2001 2003 2005 2007 2009
According to an August 2010 UCLA Health Policy Research Brief, nearly 8.4 million Californians
were without any health insurance coverage for all or some of 2009. The report backs up
the findings of a previous study the center released in March that showed nearly one in four
Californians lack health insurance. According to the latest estimates, the state’s uninsured
population has reached 24.3 percent, or about 8.4 million, up from 6.4 million in 2007.
This number represents 22.9 percent of all Californians under age 65. While the percentage of
uninsured has remained high but relatively steady for the last four to five years, it is widely believed
that the current economic condition is causing the number of uninsured to once again increase.
Last year, California hospitals spent $12 billion on uncompensated patient care, up from $8.3 billion
in 2005, according to the California Hospital Association. The number of uninsured patients is the
single biggest pressure point on hospitals. In 2009, California hospitals provided $12.2 billion in
uncompensated care. Of that amount, Medicare shortfalls accounted for nearly $3.8 billion, while
Medi-Cal underfunded hospitals by $4.6 billion and charity care by $3.8 billion5.
4 California Health Interview Survey. “Source: 2009 California Health Interview Survey,” www.chis.ucla.edu
5 A report On Californian Community Hospitals May 2010, California Hospital Association.
18
Financial Assistance
Assisting Low-Income, Uninsured Patients
The Scripps financial assistance policy is consistent with the AB774 “Fair Pricing Policy” legislation.
The practices established reflect our commitment with respect to assisting low-income, uninsured
patients with discounted hospital charges, charity care, billing and debt collection practices.
Our program is provided without regard to race, ethnicity, gender, religion or national origin.
Scripps provides full financial assistance to low-income and uninsured patients earning less than
200 percent of the federal poverty level guidelines. For individuals who qualify between 201-400
percent of the poverty level, financial assistance is based on a discount schedule. For 2011, Health
and Human Services defined the 200 percent Federal Poverty Level of a family of four as $44,700.
FY10 Scripps System Uncompensated Health Care Summary
Title Financial
Support*
Bad Debt $14,689,083
Charity Care $43,419,909
Medicare and Medicare HMO (Shortfall) $169,100,309
Unreimbursed Medi-Cal $38,550,492
Unreimbursed Other Means-Tested Government Programs (Shortfall) $20,472,593
SCRIPPS TOTAL FY10 UNCOMPENSATED CARE $286,232,394
SCRIPPS SCHEDULE H FY10 UNCOMPENSATED CARE $102,443,001
(Excludes Bad Debt and Medicare Shortfalls)
*”FINANCIAL SUPPORT” = Calculations for bad debt and charity care is estimated by extracting the gross write-offs of bad debt and
charity care charges and applying the hospital ratio of cost to charges (RCC) to estimate the cost of care. Calculations for Medi-Cal and
other means-tested government programs and Medicare shortfall are derived using the payor-based cost allocation methodology.
Bad debt and Medicare shortfall do not count as community benefits under the new Schedule H 990, but are still reportable outside the
community benefit table.
19
FIGURE 3:2
FY10 Scripps Total Uncompensated Care
by Operating Unit, $286,232,3946
Scripps Whittier
Diabetes Institute
0%
Scripps Medical
Foundation Scripps System-Wide
$53,754,940 $478,405
19% 0%
Scripps Mercy
Hospital Chula Vista Scripps Memorial
$26,250,592 Hospital La Jolla
9% $66,399,519
23%
Scripps Green Hospital
Scripps Mercy Hospital
$31,247,324
San Diego and Mercy Clinic
Scripps Memorial 11%
$67,721,532
24% Hospital Encinitas
$40,380,082
14%
Uncompensated Health Care:
Uncompensated health care includes the sum of expenses associated with charity care,
Medi-Cal and Other Means-Tested Government Programs, Medicare shortfalls and bad debt.
A detailed account of Scripps FY10 expenditures are contained in the following graphs.
6 Calculations for Medi-Cal and Other Means-Tested Government Programs and Medicare shortfalls are derived using the payor-based
cost allocation methodology. Calculations for bad debt and charity care are estimated by extracting the gross write-offs of bad debt and
charity care charges and applying the hospital ratio of cost to charges (RCC) to estimate net cost of care.
20
FIGURE 3:3
FY10 Scripps Schedule H Uncompensated Care
by Operating Unit, $102,443,0017
Scripps Whittier
Diabetes Institute
0% Scripps Medical
Foundation
$239,546
Scripps Green Hospital
0.2% Scripps Memorial $2,251,120
Hospital La Jolla 2.2%
Scripps System-Wide $19,362,432
Scripps Mercy
$363,417 18.9%
Hospital Chula Vista
$18,492,580 0.4% Scripps Memorial
18.1% Hospital Encinitas
$11,655,163
11.4%
Scripps Mercy Hospital
San Diego and Mercy Clinic
$50,078,742
48.9%
Uncompensated Health Care (Schedule H):
Uncompensated health care includes the sum of expenses associated with charity care,
Medi-Cal and Other Means-Tested Government Programs.
7 Calculations for Medi-Cal and other means-tested government programs are derived using the payor-based cost allocation
methodology. Calculations for charity care are estimated by extracting the gross write-offs of charity care charges and applying the
hospital ratio of cost to charges (RCC) to estimate the cost of care. Community-building activities, bad debt and Medicare shortfall do
not count as community benefits under the new Schedule H 990 but are still reportable outside the community benefit table.
21
FIGURE 3:4
FY10 Scripps Charity Care by
Operating Unit, $43,419,9118
Scripps Whittier
Diabetes Institute
0% Scripps Medical
Foundation
$219,482
Scripps Green Hospital
1% Scripps Memorial $970,429
Hospital La Jolla 2%
Scripps Mercy Scripps System-Wide $7,958,129
Hospital Chula Vista 0% 18%
$8,292,316 Scripps Memorial
19% Hospital Encinitas
$4,371,527
10%
Scripps Mercy Hospital
San Diego and Mercy Clinic
$21,608,027
50%
Charity Care:
Embedded within the Scripps legacy of providing quality care for all, there continues to be a
commitment to providing services to vulnerable populations. Scripps provides charity care at all
of its hospitals to those with few or no financial resources.
8 Calculations for charity care are estimated by extracting the gross write-offs of charity care charges and applying the hospital ratio of
cost to charges (RCC) to estimate the cost of providing charity care.
22
FIGURE 3:5
FY10 Scripps Medi-Cal and Other Means Tested
Programs by Operating Unit, $59,023,0909
Scripps Whittier
Diabetes Institute
0% Scripps Medical
Foundation
$20,063 Scripps Green Hospital
0% Scripps Memorial $1,280,691
Hospital La Jolla 2.2%
Scripps Mercy Scripps System-Wide $11,404,303
Hospital Chula Vista $363,417 19.3%
$10,200,265 0.6% Scripps Memorial
17.3% Hospital Encinitas
$7,283,636
12.3%
Scripps Mercy Hospital
San Diego and Mercy Clinic
$28,470,715
48.2%
Medi-Cal and Other Means Tested Programs (Shortfall):
In addition to providing charity care services, Scripps accepts patients for whom it is reimbursed
under various county, state and federal indigent care programs (CMS, Medi-Cal and Medi-Cal
HMO) at amounts that, in some cases, do not cover the full cost of care.
9 Calculations for Medi-Cal/CMS are derived using the payor-based cost allocation methodology.
23
FIGURE 3:6
FY10 Scripps Medicare and Medicare HMO
by Operating Unit, $169,100,30910
Scripps Mercy
Hospital Chula Vista
Scripps Mercy $4,922,885
Scripps Green Hospital San Diego Scripps Whittier
3%
Hospital and Mercy Clinic Diabetes Institute
$28,922,269 Scripps Memorial $12,833,957 0%
17.1% Hospital Encinitas 7.6%
$26,844,942
15.9% Scripps Medical
Foundation
$48,401,179
28.6%
Scripps Memorial Hospital
La Jolla Scripps System-Wide
$46,990,089 $114,988
27.8% 0.1%
Medicare and Medicare HMO (Shortfall):
In addition to providing charity care services, Scripps accepts patients for whom it is reimbursed
under various county, state and federal indigent care programs (Medicare, Medicare HMO) at
amounts that, in some cases, do not cover the full cost of care.
10 Calculations for Medicare are derived using the payor-based cost allocation methodology.
24
FIGURE 3:7
FY10 Scripps Bad Debt
by Operating Unit, $14,689,08411
Scripps
Green Hospital
$73,935
0.5%
Scripps Memorial
Hospital La Jolla
Scripps Whittier $46,998
Diabetes Institute 0.3%
Scripps Medical Foundation
0%
$5,114,215 Scripps
34.8% System-Wide
0%
Scripps Mercy Hospital Scripps Memorial Hospital
Chula Vista Encinitas
$2,765,126 Scripps Mercy Hospital $1,879,977
18.8% San Diego and 12.8%
Mercy Clinic
$4,808,833
32.7%
Bad Debt:
Scripps also provides benefits to the broader community, including services provided to individuals
who do not qualify for charity care but who need special services and support. Each year Scripps
provides care for which no compensation is received to persons who do not meet the criteria for
charity care, are not covered by a third-party payer or have a co-payment obligation that is not met.
11 Cost of bad debt is estimated by applying the hospital ratio of cost to charges (RCC) to the gross write-offs of bad debt, to arrive at
estimated cost of providing care.
25
Community Health Services
“Type II diabetes
We tend to develop
at younger ages and
more quickly than
the average American.
– Sahra Abdi, program volunteer ”
Community Health
Services
The City Heights Hope Group teaches East African immigrants how to select, purchase, and prepare healthy meals to prevent and diet-related health problems.
Creating Hope for Somali Immigrants,
One Meal at a Time
San Diego is home to the second largest Somali The group also addresses digestive issues developing
community in the United States, and Scripps Health is among East Africans as they increasingly adopt a
addressing the need to provide support services for the modern, western diet move away from a traditional
estimated 25,000 Somali and other East Africans now Halal diet, which restricts many high-fat animal foods
settled in and around the community of City Heights. and alcohol.
Much of Scripps’ outreach with the East African In 2010, the Center provided 76 coalition-building
community originates at the City Heights Wellness meetings, serving 2,900 individuals on classes
Center, a community-building partnership between strategically designed to empower all residents of
Scripps Mercy Hospital and Rady Children’s Hospital. City Heights to adopt or maintain healthy lifestyles.
The 4,500-square-foot center serves many diverse Classes included Behavioral Health, Chronic Disease
groups. At the heart of the center is its “teaching Management-Diabetes, Healthy Lifestyle Education,
kitchen,” a hub for East African community gatherings Nutrition, Physical Activity, Lactation Programs, Maternal
and classes. Child Health, Mental Health, and Navigating the Health
System. And during 2010, the center served a total of
Somali immigrant Sahra Abdi is the program coordinator 19,353 attendees in 1,141 class sessions.
for the Center’s Health Advocacy Project, which includes
the City Heights Hope group. “The most important work we do is to empower
community residents to manage their own health,” says
“In the City Heights Hope group, 80 women from the Sahra. The City Heights Wellness Center will continue
local community are learning to overcome barriers to a its collaborative work with other agencies in the future,
healthy lifestyle,” Sahra explains. “There is a dangerous preventing disease and promoting community health.
trend among East African immigrants to America. We
tend to develop Type II diabetes at younger ages and
more quickly than the average American. In the kitchen,
we do cooking demonstrations that teach immigrants
how to shop for and prepare nutritious foods.”
Section
4 Community Health Services
Community Health Services include prevention and wellness programs such as screenings, health
education, support groups and health fairs, which are supported by operational funds, grants,
in-kind donations, and philanthropy. These programs are designed to raise public awareness,
understanding of and access to identified community health needs documented in the Charting
the Course VI, CHIP’s 2010 Health Needs Assessment. (Refer to Section 2 – Assessing Community
Needs).
Scripps categorizes Community Health Services according to the Schedule H 990 categories
mandated by the IRS. It is categorized into five main areas: (Refer to the Scripps Community Health
Services Activity Summary for a breakdown of categories, page 55).
• Community health improvement services
• Community benefit operations
• Cash and in-kind contributions
• Subsidized health services
• Community building activities
During FY10 (October 2009 to September 2010), Scripps invested $16,016,598 in community
health services. This figure reflects the cost associated with providing such activities, including
salaries, materials and supplies, minus revenue.
Following are highlights of just some of the activities conducted by Scripps during FY10. Refer to
figure 4:1 for a graphical representation of the FY10 Scripps System Community Health Services
program distribution.
Access to Care
A lack of health insurance and access to specialty and primary care providers are two of the primary
barriers to health care on both a local and national level.
Without access to basic health care services, individuals suffer from more acute episodes of illness,
injury and mortality. It is also an increased burden on hospitals and health providers resulting from
providing uncompensated care to the uninsured. Rising rates of uninsured patients may be
26
reflected in higher use of emergency departments, which by law must provide at least stabilizing
care to all patients regardless of ability to pay. Review of the San Diego County ED discharges by
source of payment between 2006 and 2008 found the demand of ED services increased by
11.9 percent – $582,129 and $651,595 respectively. In addition, several shifts in payor sources
were noted including a decline in private HMO and Worker Compensation ED discharges and
increases in both self pay and Medi-Cal ED discharges, suggesting more patients are relying on
ED care due to lack of insurance coverage12.
In an effort to provide for populations in need, Scripps assisted in FY10 with the following examples
of health care programs and projects.
Mercy Outreach Surgical Team (MOST)
The Mercy Outreach Surgical Team (MOST) works to mitigate the effects physical deformities
have on children by providing reconstructive surgeries at no cost to children in need. In special
circumstances, surgeries also are provided for adults. During FY10, the MOST team provided
reconstructive surgeries for more than 575 children and 53 procedures were done. (Sponsored by
Scripps Mercy Hospital San Diego and affiliated physicians).
Graduate Medical Education staff support to St. Vincent de Paul Village Medical Center
and Mid-City Community Clinics
Weekly community clinics were held at the St. Vincent de Paul and Mid-City Community Clinics.
Staffed by the Scripps Green Hospital and Scripps Clinic Internal Medicine Residents, these clinics
provided medical care to approximately 286 of our county’s most vulnerable residents during FY10.
(Sponsored by Scripps Clinic/Green Hospital).
Fiji Alliance Project
In partnership with the International Relief Teams of San Diego, the Loloma Foundation,
Scripps employees, Scripps Clinic physicians and other Scripps affiliated physicians provided medical
and surgical services in Fiji to persons in need. Residents from Scripps Clinic and Scripps Green
Hospital have an opportunity to participate in the medical missions as one of their rotations.
Examples of procedures include cleft lip and palate repairs, repairs of deformities of eyelids, face
and feet, burn scar revision, breast masses, diabetes management and hernia repairs. On each trip
the group brings over $2 million dollars worth of donated medical supplies from various companies
including Scripps Health through surgical gowns, gloves, drapes, dressings, bandages, sutures,
corrective lenses, sunglasses, and tooth care products into the country. In FY10, a clinical team of
six practitioners provided care to 2,000 patients in just two weeks. (Sponsored by Scripps
Clinic/Green Hospital)
12 Reference: Community Health Improvement Partners (CHIP). Charting the Course VI 2010: A San Diego County Health Needs
Assessment. Retrieved from the World Wide Web: http://www.sdchip.org.
27
Scripps Health Community Benefit (CB) Fund
In 2010, Scripps awarded a total of $200,000 in community grants to programs based throughout
San Diego. Scripps awarded six grants ranging from $10,000 to $120,000 each. The projects that
received funding address some of San Diego County’s high-priority health needs with the goal
of improving access to vital health care services for a variety of at-risk populations, including the
homeless, economically disadvantaged, mentally ill and others. Since the Community Benefit Fund
began, Scripps has awarded $1.7 million dollars. Programs funded during FY10 include:
C
• B Fund – Consumer Center for Health Education and Advocacy (CCHEA)
Funding provides low income uninsured Mercy Clinic patients and Behavioral Health patients
who need assistance in obtaining healthcare benefits, SSI and related services, while
simultaneously reducing uncompensated care expenses for Mercy. This project provides
advocacy services for the time-intensive government benefit cases. (Sponsored by Scripps
Mercy Hospital Administration).
• CB Fund – Catholic Charities – Funding awarded to provide short-term emergency shelter
to medically fragile homeless patients being discharged from Scripps Mercy Hospital
San Diego. Case management and shelter is provided for previously homeless patients
discharged from Scripps Mercy Hospital who no longer require hospital care but do need
a short-term supportive recuperative environment. Patients demonstrating a readiness for
change are assisted with one week in a hotel along with food and bus fare to pursue case
plan. The focus of the case management is to stabilize the client by helping them connect
to more permanent sources of income, housing and ongoing supports for efforts toward
self-reliance. The goal of this partnership is to reduce the incidence of ER recidivism in this
population and improve the quality of life for the patient.
C
• B Fund – 2-1-1 New Access System – Funding was awarded for ongoing operations of its
telephone dialing code, which provides the public with information about community, health
and disaster services. 2-1-1 San Diego is the dialing code for information about community,
health and disaster services. It connects people with resources over the phone, online and in
print. Locally, 2-1-1 San Diego was launched in June 2005 as a multilingual and confidential
service committed to providing access 24/7.
C
• B Fund – Partnership for Smoke-Free Families – The Partnership for Smoke-Free
Families Program (PSF) is a comprehensive tobacco control program to reduce tobacco smoke
exposure among pregnant women and small children by systematically screening pregnant
women and new parents for tobacco use in their obstetrician’s and pediatrician’s office and
linking them with tailored interventions. PSF has become a standard of care in San Diego
County and a nationally recognized model. PSF provides a valuable resource for physicians
and smoking cessation services specifically for pregnant women and new parents that was
previously non-existent in San Diego.
28
C
• B Fund – American Heart Association – Funding awarded for the 2010 Heart Walk
sponsorship. Heart disease and stroke are the number one and number three causes of
death in the nation for men and women. Heart disease is the nation’s leading cause of death,
claiming more than 950,000 American lives each year. Scripps partners with the American
Heart Association on their annual Heart Walk, to raise funds for research, professional and
public education and advocacy.
Cancer/Oncology
Cancer is the second leading cause of death in the U.S. exceeded only by heart disease and
accounts for almost one quarter of all deaths in San Diego County. According to National Cancer
Institute (NCI) estimates, in 2009 1,479,350 new cases of cancer would be diagnosed and an
estimated 562,540 deaths related to cancer. Currently lung, breast, colorectal and prostate cancers
accounted for 53 percent of all new cases of cancer and 50 percent of all cancer deaths.
Type of Cancer 2009 US 2009 US 2007 San Diego 2007 San Diego
Estimated New Estimated Deaths Rate per 100,000
Cases Deaths
Cancer – All cases 1,479,350 562,540 4,812 162.6
Lung and bronchus 219,440 159,390 1,146 39.6
Breast 194,280 40,610 332 20.2
Prostate 192,280 27,360 273 21.8
Colon 106,100 49,920 442 14.8
In San Diego County during 2007, persons age 55 and over accounted for almost 88 percent of
cancer deaths with mortality rates per 100,000 population, ranging from 267.7 among those in the
55 – 64 age category to 1,533.5 among those age 85 and over.
Trends
Between 2000 and 2007, San Diego County’s age-adjusted mortality rate for cancer has declined
from 189.1 to 162.6 per 100,000 population13.
In response to this serious health concern, Scripps has developed a series of prevention and wellness
programs designed to educate people on the importance of early detection and treatment for some
of the most common forms of cancer. The following are some examples of cancer programs and
activities in which Scripps engaged in during FY10.
13 Reference: Community Health Improvement Partners (CHIP). Charting the Course VI 2010: A San Diego County Health Needs
Assessment. Retrieved from the World Wide Web: http://www.sdchip.org.
29
Breast and Cervical Cancer
Cancer Control – Scripps Breast Cancer Diagnosis Project
Provides free diagnostic imaging services to low-income, medically uninsured or underinsured
women age 39 and younger, and men of any age, who reside in San Diego and present with a
breast mass or abnormality. This project is funded by Susan G. Komen for the Cure, San Diego and
the Scripps Cancer Center. In FY10, 126 qualified community members participated in the program,
76 received diagnostic mammograms, 77 received breast ultrasounds and 33 received biopsies.
Four cancer cases were detected. (Sponsored by Scripps Cancer Center).
Cancer Detection Programs: Every Woman Counts
This is a state of California grant program that provides free breast and cervical cancer tailored
health education to low-income, uninsured and underinsured women who reside in San Diego
and Imperial Counties. Unfortunately, this State grant ended in June 2010. Scripps Health provided
clinical administrative oversight over 75 community-based clinics that are contracted with the
state to provide free breast cancer screenings for women age 40 and older, and cervical cancer
screenings for women age 25 and older. During FY10, the following outcomes were achieved:
Education – Breast and cervical cancer early detection and prevention education was provided to
536 qualifying women. (Sponsored by Scripps Cancer Center).
Scripps Green Cancer Center Support Groups
Scripps Green Cancer Center support groups offer cancer patients the opportunity to express
the emotions that come with a cancer diagnosis and help them cope more effectively with their
treatment regimen by nurturing their physical, emotional and spiritual well being. Classes at
Scripps Green Hospital such as the free cancer writing workshop, When Words Heal, are designed
to use expressive writing to help patients navigate their journey with cancer. In 2010, 30 cancer
patients attended a support group at Scripps Green, receiving these free services to the community.
(Sponsored by Scripps Green Hospital).
Scripps Mercy Hospital Chula Vista, Community Benefit Services
Breast Health Clinical Services
A total of 3,948 women were referred to clinical breast health services in the community and
Scripps Mercy Hospital Chula Vista radiology services. A total of 9,527 services were provided
including telephone reminders, outreach and education, case management and a variety of
presentations. (Sponsored by Scripps Mercy Hospital Chula Vista, Community Benefits).
30
Scripps Polster Breast Care Center Music as Medicine Program
Patients and their support person participate in the Music as Medicine therapy class facilitated by
a music therapist. The music therapist asks questions and tailors the therapy to the participants’
emotional and physical needs. Sessions involve listening to music, writing songs, discussing what
lyrics mean to the participants, use of singing bowls, vocalization, and drumming. Research has
shown music’s ability to boost the immune function, to block incoming pain stimuli, lower blood
pressure and influence emotional well being. (Sponsored by Scripps Polster Breast Care Center).
Scripps Polster Breast Care Center Support Groups
Scripps Polster Breast Care Center Support Groups provide a venue for women to come together,
discuss issues relating to diagnoses, and receive support. The support groups are offered to women
in the San Diego Community. (Sponsored by Scripps Polster Breast Care Center).
Cancer Center Awareness and Educational Events
A series of educational events, coordinated with American Cancer Society Awareness months, on
various types of cancer, such as breast cancer, lung cancer, cervical cancer, colorectal cancer, skin
cancer, ovarian/gynecological cancer, and prostate cancer. An RN Clinician answers questions and
provides written educational material. (Sponsored by Scripps Memorial Hospital La Jolla Cancer
Center).
Health Education and Support Groups
Education and support groups provided to San Diego County residents regarding a wide variety
of health concerns and diseases. Education and support group topics include; families who have
experienced the loss of a child, children who have lost a parent to cancer, infertility, parenting
twins, improving children’s reading abilities, Huntington’s Disease, Parkinson’s Disease, mental
illness, Ostomy, Postpartum, gynecological cancer, African American Breast Cancer, Friend to Friend,
Chronic Pain, and Multiple Sclerosis. (Sponsored by Scripps La Jolla Community Benefit Services.)
31
Cardiovascular Disease
Coronary heart disease and stroke are the number one and number three causes of death in the
nation for both men and women. Heart disease is our nation’s leading cause of death, claiming
more than 950,000 American lives every year. Stroke is America’s third killer and is a leading cause
of serious, long-term disability.
According to the American Heart Association, an estimated 80,000,000 American adults have
one or more types of cardiovascular disease (CVD). It is estimated that fewer than half of these,
38,100,000, are age 60 or older. High blood pressure, coronary heart disease (CHD) and stroke are
the most common forms of CVD. CHD was the largest single killer of Americans in 2006, resulting
in 445,687 deaths. The prevalence of CHD among U.S. adults age 20 and older was 16,800,000
and an estimated 785,000 persons in the U.S. had a new coronary attack and another 470,000 had
a recurrent attack during 2006. An estimated additional 195,000 persons had a silent attack during
this same period.
Stroke killed 137,119 people in 2006. It's the third largest cause of death, ranking behind "diseases
of the heart" and all forms of cancer. Stroke is a leading cause of serious, long-term disability in the
United States.
There are nine potentially modifiable risk factors for CVD that have been identified as consistent
in men and women across ethnic groups and regions. They include cigarette smoking, abnormal
blood lipid levels, hypertension, diabetes, abdominal obesity, a lack of physical activity, low daily
fruit and vegetable consumption, alcohol overconsumption, and psychosocial factors.
During 2007, diseases of the heart were the second leading cause of death in San Diego County,
accounting for 4,743 deaths during this period. Between 2003 and 2007, the number of heart
disease deaths dropped 12 percent from 5,404 in 2003. The age-adjusted rate of death related to
heart disease during 2007 was 151 per 100,000 population. During 2007, the San Diego County
death rate per 100,000 attributed to CHD was 112.5. Those most impacted were males 148.3,
whites 118.8, African Americans 179.0 and persons ages 65 and older, accounting for 82 percent
of CHD deaths. The San Diego death rate for stroke was 36.1 per 100,000 population. Hispanics
and African Americans have the highest rate of stroke, 43.1 and 41.0, respectively. Women, with a
rate of 36.1 accounted for 59.1 percent of San Diego County stroke deaths14.
During FY10, Scripps engaged in the following heart health cardiovascular disease prevention and
treatment activities.
14 Reference: Community Health Improvement Partners (CHIP). Charting the Course VI 2010: A San Diego County Health Needs
Assessment. Retrieved from the World Wide Web: http://www.sdchip.org.
32
American Heart Walk
Scripps allocated $10,000 in operational funds and $30,000 in in-kind donations to support
the American Heart Association’s efforts to fight heart disease and stroke. In addition, the
ScrippsAssists employee volunteer program coordinated walker participation and fund raising
efforts. The San Diego Heart Walk exceeded its goal by raising more than $1 million. In 2010,
more than 2,400 Scripps Heart Walk participants – employees, families and friends – walked to
help raise more than $149,000 Additionally, Scripps reached out to the community at the event
by providing blood pressure screenings, health education materials and more. (Sponsored by
Scripps Community Benefit Services).
Community Health Education Programs
The Community Health Education programs cover a wide variety of health related topics on
disease management, health care updates, and prevention. The topics include: Alternatives to
Hysterectomy, Stroke, Stress, Varicose Veins, Infertility, Cardiac, Depression, Macular Degeneration,
Memory, Brain, Orthopedic Care, Robotic Surgery, Skin Care, Back Care, Migraines, Knee Pain,
Pelvic Floor Incontinence, Safety and Fall Prevention, Bladder Health, Healthy Dining, Exercise,
Voice, Flu Prevention, Sleep disorders, Nutrition, Hypertension, Foot Care, Spine Surgery, Joint
Replacement, Breathing, Pain Management, and Medication Matters. (Sponsored by Scripps
La Jolla Community Benefit Services).
CPR Classes for Patients and Families of the Cardiac Treatment Center
CPR Classes offered to Cardiac Treatment Center patients and their families. CPR certification
classes (Friends and Families) offered 4 times year to patients and family members. These classes
are designed to improve community health through increased knowledge of cardiopulmonary
resuscitation practices. (Sponsored by Cardiac Treatment Center at Scripps Memorial Hospital
La Jolla).
Cardiac Treatment Center Group Exercise Programs
Cardiac Treatment Center Group Exercise Programs include: Tai Chi – twice weekly, designed to
decrease stress and improve balance; Restorative Yoga – three times a week, designed to decrease
stress, improve strength and flexibility. Fitball – twice weekly, designed to improve strength, posture,
core stability and balance. Yoga for Cancer Recovery – weekly, designed to decrease stress, improve
circulatory flow, ease tension during healing. Balance – weekly, designed to build balance, posture
and coordination. Power Yoga – twice weekly, designed to improve strength and flexibility. Pilates
– weekly, designed to improve strength, balance and flexibility. Yoga for MS – weekly, designed to
promote healing and improve strength and flexibility. Meditation-weekly. (Sponsored by the Cardiac
Treatment Center, Scripps Memorial Hospital La Jolla).
33
Stroke Care Programs
A wide variety of community education and awareness was provided on stroke related issues.
(Sponsored by Scripps Mercy San Diego and Chula Vista Stroke Program).
Heart Health – Scripps Home Health Services
Scripps Home Health provided community education to promote independent management of
congestive heart failure (CHF) in order to prevent exacerbations and hospitalizations. Education
includes what is CHF, medications, diet, weight and exercise. In FY10, 116 San Diego county
residents were served. (Sponsored by Scripps Home Health Services).
Prevention of Cardiovascular Disease – Scripps Home Health Services
Scripps Home Health provided community education to promote independent management of
Congestive Heart Failure (CHF) in order to prevent exacerbations and hospitalizations. Education
includes what is CHF, medications, diet, weight and exercise. In FY10, 100 San Diego county
residents were served. (Sponsored by Scripps Home Health Services).
Diabetes
Data from the 2007 National Diabetes Fact Sheet (the most recent year for which data is available)
estimated a total of 23.6 million children and adults in the US, 7.8 percent of the population, have
diabetes. These included 17.9 million people who have been diagnosed with diabetes and another
5.7 million people with undiagnosed diabetes. Additionally, there were 57 million people with
pre-diabetes. Each year 1.6 million new cases of diabetes are diagnosed in people aged 20 years
and older.
There are three major types of diabetes: Type 1 diabetes, Type 2 diabetes, and gestational diabetes.
All three types of diabetes share the same basic characteristic – the body’s inability either to make
or to use insulin. Without enough insulin, glucose stays in the blood, creating high levels of blood
sugar. Over time, this buildup causes damage to kidneys, heart, nerves, eyes, and other organs.
Type 1 diabetes most often occurs during childhood or adolescence, accounting for 5 percent to
10 percent of all diagnosed cases of diabetes. Type 2 diabetes typically occurs later in life,
frequently as the result of obesity, physical inactivity and other risk factors. Type 2 diabetes accounts
for 90 percent to 95 percent of diabetes cases. However, due to the current obesity epidemic, it
is estimated that 39 percent of the girls and 33 percent of the boys who are now healthy 2½ to
3-year-olds are likely to develop diabetes.
More than 90 million Americans (33 percent) live with a chronic disease. While there are many
disabling chronic diseases, diabetes has been identified as one of the primary chronic conditions
in San Diego County. As the seventh leading cause of death in San Diego County during 2007,
diabetes was responsible for 2.7 percent (520) of deaths during this period. In San Diego County,
34
the age-adjusted estimate of adults diagnosed with diabetes in 2007 was 6.7 percent. Nationally,
diabetes was the sixth leading cause of death during 2006, accounting for 72,449 deaths during
this period.
Health Consequences
The complications associated with diabetes are significant and well established. The CDC reports
complications including heart disease, stroke, hypertension, blindness, kidney disease, pregnancy
complications, lower-limb amputations, periodontal disease and nervous system disease.
T
• he age-adjusted rate of hospitalization for persons with diabetes among San Diego County
residents in 2008 was 128.5 per 100,000 population, an 18.9 percent increase since 2001.
I
• n 2008, Hispanics and African Americans living in San Diego County had diabetes-related
hospitalization rates 1.8 and 2.6 times higher than that of the overall population.
I
• n San Diego County, the age-adjusted diabetes-related mortality rates decreased from
21.4 per 100,000 population in 2005 to 17.5 in 2007, an 18.2 percent decrease.
I
• n 2007, diabetes was the seventh leading cause of death in San Diego County, accounting
for 520 deaths.
I
• n 2007, diabetes was the seventh leading cause of death in the U.S. with an age-adjusted
death rate for diabetes at 23.5 per 100,000 population. Among those 65 and over, diabetes
was the sixth leading cause of death with a death rate of 135.6 per 100,000 population.
Over six million Americans are unaware they have diabetes. The complications related to diabetes
are serious and can be reduced with preventive practices. Leading to school and work absenteeism,
an elevated rate of hospitalization, frequent emergency room visits, permanent physical disabilities
and sometimes death, diabetes is a serious community health problem. During FY10, Scripps
engaged in the following diabetes management initiatives15.
Project Dulce
Formed through collaboration between The Scripps Whittier Diabetes Institute, the Council
of Community Clinics, and Community Health Improvement Partners (CHIP). Project Dulce is
a comprehensive, culturally competent diabetes management program for underserved and
uninsured populations in San Diego County. Project Dulce incorporates the Chronic Care Model in
its team-based approach to care. Project Dulce has been working in communities across
San Diego for the past 10 years by providing diabetes care and self management education.
Nurse-led teams focus on achieving measurable improvements in the health of their patients;
nurse educators lead multidisciplinary teams that provide clinical management; and peer educators
from each cultural group, known as promotoras, provide public and patient education to their
perspective communities. This innovative program combines state-of-the-art clinical diabetes
15 Reference: Community Health Improvement Partners (CHIP). Charting the Course VI 2010: A San Diego County Health Needs
Assessment. Retrieved from the World Wide Web: http://www.sdchip.org.
35
management with proven educational and behavioral interventions. Project Dulce provided
8,120 diabetes care and education visits for low-income and underserved individuals throughout
San Diego in FY10, and enrolled more than 1,148 new patients in Project Dulce. The program
also initiated four new programs: 1) Diabetes Prevention for Women with a History of Gestational
Diabetes; 2) Replicating Project Dulce in Tijuana; 3) Diabetes Peer Care Coordination Project at
Scripps Mercy Chula Vista Hospital, and 4) Diabetes Genebank Program.
Scripps Whittier Diabetes Institute Professional Education and Training
The Scripps Whittier Diabetes Institute professional education teams provide state-of-the-art
education and training for people who wish to increase their diabetes management knowledge and
skills. With the rise in the number of people with diabetes, medication upgrades, nutrition changes
and changes in diabetes related devices, there is a great need to equip health care professionals
with the latest information and clinical practice skills. The Whittier’s professional education program
is led by a team of experts that include endocrinologists, nurses, dieticians, psychologists, and other
diabetes specialists, these individuals train practicing professionals to deliver the best care possible
for their patients with diabetes. Courses are designed to respond to the needs of allied health
professionals seeking an understanding of the new and complex clinical treatment options for
Type 1, Type 2 and gestational diabetes. These courses provided professional education to
1,346 individuals on diabetes topics, including insulin management, incretin therapy, the diabetes
diet, the basics of diabetes, home health education and a 5-day comprehensive training for
diabetes care professionals. Individuals came from throughout the United States, as well as from
local health institutions, to learn from the Whittier Institute’s most experienced diabetes experts,
including endocrinologists, nurses, dieticians, psychologists and community educators. Over the last
year, the Whittier Institute’s professional education department provided 53 separate programs to
physicians, nurses, pharmacists, social workers, dietitians, mid-level providers and social workers.
36
Health Related Behaviors
Health-related behavior is one of the most important elements in people's health and well-being.
Its importance has grown as sanitation has improved and medicine has advanced. Diseases that
were once incurable or fatal can now be prevented or successfully treated. Health-related behaviors
such as immunization, smoking cessation, improved nutrition, increased physical activity, oral
health, and injury prevention have become important components of long-term health.
Understanding that personal behaviors play a significant role in an individual’s overall health status,
Scripps has developed a series of prevention and wellness programs that help people take charge of
their own health and that of their families. During FY10, Scripps participated in a number of health
behavior modification efforts.
Flu Vaccination Campaign
According to the Centers for Disease Control and Prevention (CDC), an average of 50,000
adults dies annually in the United States from diseases that are preventable through vaccination.
Approximately 36,000 adults die from influenza, over 6,000 from invasive pneumococcal disease,
and 5,000 from hepatitis B. In San Diego County, influenza and pneumonia were the tenth leading
cause of death in 2007, with 1,111 deaths recorded between 2005 and 200716.
Based on 2007 CHIP data, only 34.6 percent of San Diego County residents reported receiving
an influenza vaccination during the past 12 months. Behavioral Risk Factor Surveillance System
(BRFSS) data for 2008 reported only 26.5 percent of adults aged 65 and over had been vaccinated
for influenza during the past 12 months. Vaccinations may not be received due to cost and
local availability issues or a lack of education about timing and effectiveness. Misunderstanding,
misinformation, or skepticism related to the benefits and possible disks associated with vaccines
may also reduce vaccination rates.
In an effort to minimize the number of persons that contract pneumonia and influenza, Scripps is
committed to ensuring that high-risk populations have access to flu vaccinations regardless of their
ability to pay. In partnership with the County of San Diego, Scripps administered more than
300 doses17 of the flu vaccination to high-risk populations throughout San Diego County in FY10.
16 Reference: Community Health Improvement Partners (CHIP). Charting the Course VI 2010: A San Diego County Health Needs
Assessment. Retrieved from the World Wide Web: http://www.sdchip.org
17 Represents vaccinations provided through community outreach efforts and does not include vaccine provided to patients being
treated within Scripps hospitals or receiving care from a Scripps affiliated physician. (Vaccine provided by the San Diego Health and
Human Services Agency). Scripps’ participation led by Scripps Memorial Hospital Encinitas, Community Benefit Services.
37
Maternal Child Health
The health of mothers, infants, and children is a reflection of the current health status of a large
segment of the US population and a health predictor for the next generation. The focus of the
information in this topic includes indicators of maternal illness and death and those that affect
infant health and survival. Among these are information related to infant mortality rates, access
to preventive care, and fetal, peri-natal, and other infant deaths.
There are numerous risk factors associated with maternal and infant health, including:
A
• lcohol, tobacco, and illegal substances during pregnancy – A major risk factor for
low birth weight and other poor infant outcomes
V
• ery low birth weight – Associated with preterm birth, spontaneous abortion,
low pre-pregnancy weight, and cigarette smoking
I
• nfant death – Rates are highest among infants born to young teenagers and
mothers aged 44 years and older
Being pregnant or trying to become pregnant accounts for a small portion of a woman’s life.
An unintended pregnancy is a pregnancy that is either mis-timed or unwanted at the time of
conception. Unintended pregnancy accounts for an estimated 49 percent of all pregnancies in
the U.S. and is associated with increased morbidity and with behaviors during pregnancy that are
linked with adverse health effects. Women who can plan the number and timing of the births of
their children enjoy improved health, experience fewer unplanned pregnancies and births, and have
lower rates of abortion.
Who is Most Impacted
During 200818, San Diego County’s crude birth rate per 1,000 population was 14.9, accounting
for 46,742 live births. Crude birth rates ranged from 9.2 among white women to 22.3 among
Hispanic women. During 2008, Hispanics accounted for 44.7 percent of all live births, followed by
30.9 percent for whites. Women between the ages of 20 and 34 accounted for 74.2 percent of
births. Scripps Health continued to enhance prenatal education offerings for low-income women
in San Diego County in FY10. The following are examples of programs:
Scripps Memorial Hospital La Jolla, Community Benefit Services
O
• ffered a total of over 575 Maternal child Health classes throughout San Diego County
designed to enhance parenting skills. Low-income women in the county of San Diego were
eligible to all attend classes at no charge or on a sliding fee schedule.
M
• aintained existing prenatal education services in all regions of the county, ensuring that
programs continued to demonstrate a more than 90 percent satisfaction rating.
P
• rovided and supported five weekly breastfeeding support groups throughout
San Diego County. This includes two with bilingual services.
18 Reference: Community Health Improvement Partners (CHIP). Charting the Course VI 2010: A San Diego County Health Needs
Assessment. Retrieved from the World Wide Web: http://www.sdchip.org.
38
O
• ffered a maternal child health education series covering issues such as Dogs and Babies:
Safety, Grandparenting, and Babysitter Safety in the North County.
O
• ffered the following maternal child health classes at the Mende Well Being Center:
Basic Training for Dads, Breastfeeding, Childbirth Preparation, Getting Ready for Baby,
Infant CPR and Safety, Parent Connection programs, Redirecting Children’s Behavior and
Sibling classes.
O
• ffered Dogs and Babies program quarterly with more than 50 attendees.
O
• ffered bi-weekly Mommy and Me Yoga and Infant Massage Programs to new parents.
O
• ffered a prenatal yoga program for expectant women in San Diego County.
O
• ffered a Pregnancy Nutrition program quarterly at Scripps Memorial Hospital La Jolla.
D
• eveloped and offered “Pelvic Floor and Pregnancy Changes” for expectant families at
Scripps Memorial Hospital La Jolla.
(Sponsored by Scripps Memorial Hospital La Jolla, Community Benefit Services).
Healthy Start Case Management Services
A total of 300 or more high-risk pregnant women were case managed throughout the year.
A total of 6,261 services were provided, including home visits, phone calls, bus tokens and
educational materials. (Sponsored by Scripps Mercy Hospital Chula Vista, Community Benefits).
First 5
More than 398 services were received for first-time mothers, including: home visits, referrals
received, data entry, follow up phone calls, parenting classes and other support services.
(Sponsored by Scripps Mercy Hospital Chula Vista, Community Benefits).
Substance Abuse and Tobacco Use
Substance abuse has a major impact on individuals, their families, and their communities.
The effects of substance abuse are cumulative, contributing to costly social, physical, mental and
public health problems. These problems include teenage pregnancy, HIV/AIDS, other sexually
transmitted diseases (STDs), domestic violence, child abuse, motor vehicle crashes, physical fights,
crime, homicide and suicide19.
According to the National Institute on Drug Abuse, the total estimated annual costs associated
with substance abuse exceed half-a-trillion dollars. This includes approximately $181 billion for illicit
drugs, $168 billion for tobacco and $185 billion for alcohol. During 2009, California’s estimated
healthcare costs directly caused by smoking were $9.14 billion.
19 Community Health Improvement Partners (CHIP). Charting the Course VI 2010: A San Diego County Health Needs Assessment.
Retrieved from the World Wide Web: http://www.sdchip.org.
39
Tobacco Use
D
• uring 2007, based on the Youth Risk Behavior Surveillance Survey (YRBSS), 43.6 percent of
students in grades 9–12 within the San Diego Unified School District reported they had ever
tried cigarette smoking.
D
• uring this same time period, 11.0 percent of students in grades 9-12 reported current
cigarette use and 7.0 percent reported they smoked more than 10 cigarettes per day.
O
• f those students who reported they currently smoke, 41.4 percent reported they have tried
to quit smoking at least once during the past 12 months.
D
• uring 2008, based on Behavioral Risk Factor Surveillance System data for San Diego County,
14.5 percent of adults aged 18 or older currently smoke. Twenty-three percent are former
smokers and 62.5 have never smoked.
Alcohol Use
D
• uring 2007, based on the YRBSS, 72.0 percent of students in grades 9-12 within the
San Diego Unified School District reported they had at least one drink of alcohol on at
least one day during their life.
D
• uring this same time period, 36.7 percent of students in grades 9-12 reported they had
at least one drink of alcohol on at least one day during the 30 days prior to the survey.
E
• pisodic heavy drinking, having five or more drinks of alcoholic in a row within a couple
of hours on at least one day during the 30 days prior to the survey, was reported by
21.8 percent of students.
D
• uring 2008, based on Behavioral Risk Factor Surveillance System data for San Diego County,
55.1 percent of adults aged 18 or older have had at least one drink during the past 30 days.
In an effort to encourage more people to take steps to prevent substance abuse, Scripps engaged
in the following activities:
Intervention Workshops Aim to Improve Community Health
The intervention program at Scripps McDonald Center offers free workshops for parents to help
them better understand adolescent alcohol and substance abuse and the widespread problem of
teen addiction. Other intervention workshops address the warning signs of adult addiction for
families and employers, providing age-specific information on how to help loved ones recognize
the signs of addiction and how to get an addicted individual to seek treatment. More than 11,000
people attended the workshops on the Scripps Memorial Hospital La Jolla campus in 2010.
40
Every 15 Minutes
The Every 15 Minutes program is a two-day event that exposes high school students to the
consequences of drinking and driving through a dramatic reenactment of an alcohol-related
traffic accident. The “injured” students are taken to Scripps Mercy Trauma Center. This program is
sponsored jointly by local high schools, county police, sheriffs, California Highway Patrol, emergency
departments and ambulance services. During FY10, Scripps Mercy Hospital participated in three
Every 15 Minutes programs, reaching more than 3,000 high school students in San Diego County’s
East and Central regions. (Sponsored by Scripps Mercy Hospital San Diego Trauma Centers).
Partnership for Smoke-Free Families Program (PSF)
Cigarette smoking has been identified as the most important source of preventable morbidity and
premature mortality worldwide. Cigarette smoking causes heart disease, several kinds of cancer
(lung, larynx, esophagus, pharynx, mouth and bladder) and chronic lung disease.
Approximately 11 percent of pregnant women smoke. An estimated 25-60 percent of all female
smokers quit shortly after learning they are pregnant (recent quitters). Among those who quit
on their own, 20 percent to 40 percent will go back to smoking during pregnancy. In the US,
25 percent of children under the age of six years live in a house where some¬one smokes inside
at least four days per week.
Prenatal Risks
Smoking during pregnancy has been shown to cause adverse outcomes including miscarriage,
placental abruption and separation and increased peri-natal mortality. It accounts for 20 percent
of low birth weight deliveries, eight percent of preterm births, and five percent of all prenatal deaths.
Infant/Child Risks
The effects of maternal smoking are not limited to the prenatal period. More infants die of
Sudden Infant Death Syndrome (SIDS) when the mother smoked during pregnancy or after the
birth. Children of smokers have more respiratory problems, ear infections, asthma, and doctor
visits. Children whose parents smoke are more likely to have behavior problems and trouble
with schoolwork.
Launched in 1998 by the CEOs of Rady Children’s Hospital, Scripps and Sharp HealthCare,
PSF has the goal of reducing tobacco smoke exposure among pregnant women and young
children. The program works directly with obstetricians and pediatricians across San Diego County
to implement “best practices” as outlined in the USDHHS Treating Tobacco Use and Dependence
Clinical Practice Guideline. PSF has become a standard of care in San Diego County, and is
recognized nationally. As of November 30, 2010 nearly 300,000 pregnant women and parents of
small children have been screened for tobacco use/exposure and more than 55,000 proactively linked
with targeted interventions. (Sponsored by Scripps Health System, Community Benefit Services).
41
Hospitalized Patients Smoking Cessation Study
A total of 126 participants were included in the pilot randomized control trial to assess how best
to assist hospitalized smokers quit smoking. This study is a partnership with the California Smokers
Helpline. A larger study will be implemented in 2011. (Sponsored by Scripps Mercy Hospital
Chula Vista).
Youthful Drinking and Driving Program
Considering that at least 74.3 percent of high school students in the U.S. report drinking alcohol,
it is imperative that students understand the risks associated with alcohol abuse. In an effort to
educate at-risk students about the dangers associated with drinking and driving, Scripps Mercy
Hospital’s Emergency Department and Trauma Center participated in the Corrective Behavior
Institute’s Youthful Drinking and Driving Program, providing 48 teens with a trauma center
visitation experience. This four-hour supervised trauma visitation program for young drivers ages
14 and over to show them the realistic consequences of driving under the influence. Participants
visit the trauma room, ER, ICU, CAT scan and other hospital areas. (Sponsored by Scripps Mercy
Hospital’s Emergency Department and Trauma Center).
San Diego County Policy Panel on Youth Access to Alcohol
Scripps participates on a panel which works to shape local, state and national policies that affect
underage drinking. It is the lead organization for the region’s Combating Underage Drinking
Initiative, and provides structure to support the project’s strategies through media advocacy,
data collection, and responsible beverage service training and youth participation. (Sponsored by
Scripps Mercy Hospital, Trauma Services).
San Diego County Methamphetamine Strike Force (MSF)
Convened in 1996 by the County Board of Supervisors, this multiagency group is tasked with the
development of a regional prevention and treatment strategy to address methamphetamine abuse.
Scripps Mercy Hospital Trauma Services is on the Coordinating Committee and the Information and
Education (Research) Team, which studies and monitors regional substance abuse trends. The Strike
Force tracks its progress with an annual Report Card of 10 indicators. The Strike Force programs
have been duplicated in several other parts of the United States. (Sponsored by Scripps Mercy
Hospital, Trauma Services).
42
Unintentional Injury and Violence
In California, injury, including both unintentional and intentional, is the number one killer and
disabler of persons aged 1 to 44 (CDPH, 2010)20.
The numbers of deaths associated with unintentional injury are significant, yet present only a small
part of a much larger and serious public health problem. Hospitalization data is more indicative of
the extent of the injury problem than death data alone.
In San Diego County during 2008, there were more than 930 deaths, more than 20,800 San Diegans
hospitalized and nearly 150,000 treated in emergency departments (EDs) for unintentional injuries.
The number of unintentional injuries treated in physicians’ offices and clinics related to unintentional
injury, while unknown, is likely much higher than the number of emergency department visits.
Unintentional injuries are one of the leading causes of death for San Diego County residents of all
ages, regardless of gender, race, or region. During 2008, unintentional injury was the leading cause
of death for persons ages 1 to 4 years and 15 to 34 years and the sixth leading cause of death
overall. More than 930 San Diegans died in 2008 as a result of unintentional injuries.
During 2008, there were 149,900 unintentional injury discharges from San Diego County EDs,
accounting for almost one in four (24.2 percent) of all ED discharges during this period. The rate of
ED discharges related to unintentional injury was 4,735 per 100,000 and represented the lowest rate
during the past three years.
Unintentional injuries can occur at home, at work, while participating in sports and recreation, on
the streets, and at school. Causes of unintentional injuries include motor vehicle accidents, falls,
firearms, fire/burns, drowning, poisoning (including drugs and caustic substances) and alcohol, gas,
cleaners and injuries at work.
The following are some of Scripps Health programs that address unintentional injuries and violence
for FY10.
Health and Safety Fair – Scripps Home Health Services
This fair provided education for seniors on fall prevention (primary causes of falls and fractures) and
fire safety. Home Health nurses provided information to seniors and their families on continuum of
care options. In FY10, 550 San Diego residents were served. (Sponsored by Scripps Home Health
Services).
20 Community Health Improvement Partners (CHIP). Charting the Course VI 2010: A San Diego County Health Needs Assessment.
Retrieved from the World Wide Web: http://www.sdchip.org.
43
Fall Prevention – Scripps Memorial Hospital La Jolla and the Lawrence Family Jewish
Community Center
Partnered to offer a class taught by trauma care experts to learn ways to reduce fall risk, improve
safety awareness and utilize available resources to promote independence and overall safety.
Forty-six participants from the community attended this class. (Sponsored by Scripps Memorial
Hospital La Jolla).
Sports Concussion Program – Rehabilitation Center at Scripps Memorial Hospital Encinitas
Every year in the U.S., almost 300,000 sports-related concussions occur per year – 100,000 in
football alone. Approximately 130,000 high school athletes suffer a concussion. A recent report
showed that close to 40 percent of high school athletes who sustain a concussion return to play
too soon. The Rehabilitation Center at Scripps Encinitas has developed a public education and
community outreach program designed to bring awareness to concussion, signs and symptoms
of concussion, how to avoid them, treat them and understand their consequences. Four hundred
students have been served by this program. (Sponsored by Scripps Memorial Hospital Encinitas).
San Diego Fall Prevention Task Force
This County HHSA – Aging and Independence Service-supported Task Force seeks to reduce falls
and their devastating consequences in San Diego County. Goals and strategies include: (1) increase
connections between physicians and other community service providers that provide fall prevention
services; (2) increase awareness among older adults and service. Scripps Mercy Hospital Trauma
department participates in this task force.
Weight Status, Nutrition, Activity and Fitness
The numbers speak for themselves – 63 percent of American adults are either overweight or obese.
Nationally, the prevalence of obese adults (those with a body mass index [BMI] of 30 or more)
has increased by 68 percent since 1995, from 16 percent to almost 27 percent. During this same
period, the prevalence of overweight adults has increased by only two percent, 35.5 percent to
36.2 percent.
2009 Behavioral Risk Factor Surveillance System (BRFSS) data for San Diego County indicates that
almost 59 percent of the adult population is considered either overweight or obese. Since 2005,
the first year BRFSS data was reported for San Diego County, the prevalence of obese adults has
ranged from 20 percent in 2005 to 26.7 percent in 2006, with the most current measure at
21.6 percent. Since 2006, the prevalence of overweight adults in San Diego County has increased
slightly, from 36.5 percent to 37.7 percent.
Review of adult overweight and obesity prevalence data by ethnicity, race and gender indicates the
prevalence rates of obesity among Latinos and African Americans are significantly higher than those
for whites at the national, state and county levels.
44
Obesity rates by gender also varied significantly in the 2007 CHIS, the most recent county level data
available by gender, with 25.4 percent of males and 18.1 percent of females having a BMI of
30.0 or higher. Males were significantly more likely to be overweight (BMI between 25.0 and 29.99)
than females, 40.5 percent and 25.8 percent, respectively.
Causes of Obesity
Many factors play a role in overweight and obesity, making it a complex health issue to address.
Some of the factors that are major contributors to the obesity epidemic include (DHHS, 2010):
• Genetic predisposition
• Environmental influences
• Behavior (dietary patterns and physical activity)
• Cultural influences
• Socioeconomic status
In the context of prevention, it is important to understand the affect each of these factors has on
obesity and which can be changed as a means of reducing the prevalence of obesity. The following
are some examples of Scripps programs that address the health issues described above21.
Nutrition Services
According to the 2009 Behavioral Risk Factor Surveillance System (BRFSS) data for San Diego
County, more than 59 percent of the adult population is considered either overweight or obese.
Obesity increases the health risk for chronic diseases, such as heart disease, Type 2 diabetes, high
blood pressure, stroke and some forms of cancer. At even greater risk are the nation’s low-income
minority populations. In an effort to address this critical health concern, staff members based at
the City Heights Wellness Center have established a variety of nutrition education and counseling
services, designed specifically to meet the needs of low-income minority populations. The center
uses a combination of approaches to address a broad array of community health priorities,
including nutrition, access to services and community engagement. The “hub” of the Wellness
Center is a teaching kitchen; a hands-on interactive setting for cooking demonstrations, weight
management and meal preparation classes, nutrition education and counseling. During FY10,
more than 3,000 people accessed nutrition education and counseling services at the City Heights
Wellness Center. (Sponsored by Scripps Mercy Hospital, Community Benefit Services).
Scripps Mercy’s Supplemental Nutrition Program for Women, Infants and Children (WIC)
Scripps Mercy Hospital is one of five regional organizations that administer the State-funded WIC
program, serving 6 locations that are conveniently situated either in or next to community clinics
and/or hospitals in the Central San Diego area of San Diego County. WIC’s target population is
low-income pregnant and postpartum women, infants and children (ages 0 to 5). On an annual
21 Community Health Improvement Partners (CHIP). Charting the Course VI 2010: A San Diego County Health Needs Assessment.
Retrieved from the World Wide Web: http://www.sdchip.org
45
basis, Scripps Mercy WIC serves approximately 9,000 women and children with 44 percent in the
City Heights community. The client base in City Heights is 91 percent Hispanic and made up of
pregnant and postpartum women (24 percent), infants (20 percent) and children (56 percent).
In FY10, the program provided nutrition services and food vouchers to 108,158 women and
children in the South and Central regions of San Diego. (Sponsored by Scripps Mercy San Diego).
Healthy Live Healthy – Family Nutrition Program
Using the Cooperative Extension’s research-based curriculums and bilingual staff, a registered
dietitian supervised the implementation of weekly nutrition education classes in Spanish.
This program targets the low-income, food stamp population. It consists of a series of eight weekly
classes and the primary goal is to increase knowledge, skills and motivational level of area residents
to practice healthy eating and related behaviors. Class topics focus on nutrition, physical fitness,
food safety, meal planning and food shopping. (Sponsored by Scripps Mercy Hospital, Community
Benefit Services).
Mental Health and Mental Disorders
According to the National Institute of Mental Health (NIMH), annually, an estimated 13 million
American adults (approximately 1 in 17) have a seriously debilitating mental illness (NIMH, 2008).
Furthermore, mental health disorders are the leading cause of disability in the U.S., accounting for
25 percent of all years of life lost to disability and premature mortality (WHO, 2004). Moreover, in
2007, suicide was the 11th leading cause of death in the U.S., accounting for over 34,500 deaths
(NVSS, 2010).
San Diego County – Prevalence of Serious Mental Illness
There are 141,420 persons in San Diego County with serious mental illness, representing
4.9 percent of the household population in San Diego County (DMH, 2007). The most impacted by
serious mental illness in San Diego are persons under age 18 and those living in households under
200 percent of the federal poverty level, 7.4 percent and 8.8 percent respectively.
Emergency Department Discharges
During 2008, there were 25,468 discharges from San Diego County hospital emergency
departments with a primary diagnosis of mental disorder, accounting for 4.1 percent of all ED
discharges. (Note: The primary diagnosis of mental disorder includes a wide range of diagnoses
including alcoholic and drug psychoses, dependence and abuse.) The overall rate of ED discharges
with a diagnosis of mental disorder was 809.5 per 100,000 population.
Hospitalizations
During 2008, there were 22,971 hospitalizations in San Diego County hospitals with a principal
diagnosis code of mental disorders (ICD-9-CD code 290 – 319), accounting for 7.4 percent of all
hospitalizations. These hospitalizations included 17,556 with a principal diagnosis of psychoses,
46
accounting for 59 percent of all mental health hospitalizations. There were 6,210 with a principal
diagnosis of schizophrenic disorders and 4,583 with a principal diagnosis of major depressive
disorder, account for 27 percent and 20 percent of all mental health hospitalizations, respectively
(CoSDEPI, 20010).
Suicide and Suicide Attempts (Self-Inflicted Injury)
Suicide occurs when a person ends his or her life and is a major complication of depression.
In 2008, it was the eighth leading cause of death in San Diego County, accounting for 369 deaths
with an overall rate of 11.3 suicide deaths per 100,000 people (SDEpi, 2010). Suicide deaths
are only part of the problem. More people survive suicide attempts than actually die. Those who
attempt suicide are often seriously injured and require medical and psychiatric care. Between 2000
and 2008, 2,896 San Diegans have died as a result of suicide22.
Scripps offers both inpatient and outpatient adult behavioral health services at the Scripps Mercy
Hospital San Diego campus. Scripps Mercy’s Behavioral Health program also actively supports
community programs designed to reduce the stigma of mental illness and help affected individuals
live and work in the community.
Scripps Health Behavioral Health Inpatient Programs
Individuals suffering from acute psychiatric disorders are sometimes unable to live independently
or may even pose a danger to themselves or others. In such cases, hospitalization may be the most
appropriate alternative. Scripps Mercy Hospital’s Behavioral Health Inpatient Program helps patients
and their loved ones work through short-term crises, manage mental illness and resume their
daily lives.
Challenges
L
• ike many behavioral health programs across the country, funding is difficult, as payment
rates have not kept pace with the cost to provide care.
• In 2010, Scripps Mercy’s Behavioral Health Program lost $5.1 million.
• In 2010, 20 percent of patients in the inpatient unit were uninsured.
22 Community Health Improvement Partners (CHIP). Charting the Course VI 2010: A San Diego County Health Needs Assessment.
Retrieved from the World Wide Web: http://www.sdchip.org.
47
Scripps Health Behavioral Health Outpatient Programs
Scripps Mercy provides community-based adult psychiatric treatment at Scripps Mercy San Diego.
The outpatient program is an intensive day program designed to help individuals reduce their
symptoms while they continue to live in the community.
The program provides two levels of care:
T
• he outpatient program offers patients one to four treatment days per week.
T
• he partial hospitalization program provides more intensive treatment five to six days
per week.
Mental Health Outreach Services
A-Visions Service Program
Behavioral Health Services at Scripps Mercy Hospital established the A-Visions Vocational Training
Program in partnership with the San Diego Mental Health Association to help decrease the stigma
of mental illness. The program helps people receiving mental health treatment by providing
vocational training, potentially leading to a greater level of independence. This year, Behavioral
Health continued participation in the A-Visions program (social rehabilitation and prevocational
services for people living with mental illness). In FY10, 54 clients were served. Currently eight
people are volunteering and 16 people are participating in supportive employment.
Increase Awareness of Mental Health and Geriatric Psychiatric Issues
In FY10, Scripps Behavioral Health Department improved awareness of mental health and
geriatric issues by providing information and supportive services to more than 900 people at
community events.
Mental Health Emerging Issues
Healthy People 2020 has identified several mental health issues that have emerged among some
special populations. These include post-traumatic stress disorder (PTSD) among veterans and others
who have experienced some type of traumatic event. These traumatic events may include: War,
rape, natural disasters, a car or plane crash, kidnapping, violent assault, sexual or physical abuse
and medical procedures (especially in children).
Scripps Memorial hospital at Encinitas offers a two-day course called “Brain Injury Rehabilitation
Conference: Beyond the Hospital, Into the Community.” This course on PTSD and stress
disorder is designed to provide strategies and a framework for the management of brain injured
patients both within and outside the clinical setting. Treatments are focused on the total care
continuum — physical, cognitive, perceptual, emotional and social — in a multidisciplinary format.
This conference also provides the participant with theoretical, practical, and advanced applications
in brain injury rehabilitation. The course is taught by an interdisciplinary team of specialists in brain
injury rehabilitation at Scripps Memorial Hospital Encinitas.
48
Infectious Disease
Sexually transmitted diseases and HIV/AIDS
Sexually transmitted diseases (STDs) have been referred to by the Institute of Medicine as a “hidden
epidemic of enormous health and economic consequence in the U.S. They are hidden because
many Americans are reluctant to address sexual health issues in an open way and because of the
biological and social characteristics of these diseases.” STDs encompass more than 25 infectious
organisms transmitted primarily through sexual activity. Local, state and national health agencies
are responsible for surveillance and monitoring of STDs.
Selected STD cases and rates per 100,000 population for San Diego County – all ages by
race/ethnicity, January – December 2009
All races Asian/Pacific African Hispanic White
Islander American
Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate
Chlamydia 14,219 451.6 636 193.5 1,266 761.3 3,100 329.7 2,083 131.8
Gonorrhea 1,850 58.8 51 15.5 226 135.9 238 25.3 256 16.2
Early Syphilis 394 12.5 15 4.6 43 25.9 136 14.5 196 12.4
Tuberculosis
Tuberculosis (TB) is an airborne infectious disease caused by the bacterium Mycobacterium
tuberculosis, which usually affects the lungs, although other organs and tissues such as the kidney,
spine, and brain can be affected as well. TB can be spread by coughing, sneezing, laughing or
singing. During 2009, there were 264 tuberculosis cases. Individuals most commonly diagnosed
with TB are Hispanic (52.3 percent) or Asian/Pacific Islander (31.1 percent), male (62.5 percent) and
between the ages of 25 and 64 years (61 percent)23.
23 Community Health Improvement Partners (CHIP). Charting the Course VI 2010: A San Diego County Health Needs Assessment.
Retrieved from the World Wide Web: http://www.sdchip.org.
49
HIV/AIDS
As of December 31, 2008, 13,820 Acquired Immunodeficiency Syndrome (AIDS) cases have been
reported in San Diego County since 1981. Individuals most commonly diagnosed with AIDS in
San Diego County are white, male, aged 30 to 39 years and have male sex partners.
During this period, 3,847 Human Immunodeficiency Virus (HIV) cases have been reported. Because
of a change in the HIV reporting system, all HIV reporting data currently available covers the period
April 17, 2006 through December 2008. Individuals most commonly diagnosed with HIV are white,
male and aged 30 to 39.
Scripps Health addresses infectious disease with a few of the following programs.
Scripps Mercy Hospital Chula Vista Well-Being Center
Senior Prevention and Wellness
Senior Health Chats were implemented to provide health education to the older adult community
in South Bay. Approximately 25-20 seniors attended these monthly throughout the year.
These presentations included a variety of health and age-related prevention and wellness.
One of the topics was how to prevent and treat Tuberculosis. In addition, information was
presented about signs and symptoms. These presentations are facilitated by various Scripps Mercy
health care professionals, physicians and family medicine residents. Topics are all chosen by the
seniors themselves so as to meet their local needs. Also, the health chats provide an interchange
between the community members and medical residents and other health care professionals to
foster healthy lifestyles and health prevention. Scripps Mercy Hospital Chula Vista Well Being Center
staff prepare and conduct these sessions with the seniors to foster health prevention, awareness
and dialogue between the seniors. Many questions are asked about chronic health issues and other
geriatric related health concerns.
Scripps Mercy Hospital Chula Vista Well-Being Center
Youth Prevention and Wellness
Scripps Mercy Hospital health care professionals, family medical residents, dieticians, nurses and
doctors, enlighten students in the classroom of ten local South Bay high schools on health related
topics. Some of the topics included Sexually Transmitted Illnesses and Tuberculosis 101. Students
received health career tools/brochures that included information on prevention and detection as
well as treatment, signs and symptoms.
Scripps Mercy Hospital Family Medicine Residents run two health clinics established at Palomar and
Southwest High School for residents to gain additional skills in adolescent medicine, and for youth
to gain the knowledge, attitudes, and skills necessary to pursue health careers. Family medicine
residents and faculty interact twice per week at the clinic providing adolescent medicine. Some
teaching and education takes place one-on-one with students regarding Sexually Transmitted
Illnesses prevention, signs, symptoms and treatment. Also, information is presented on Tuberculosis
prevention, signs, symptoms and treatment.
50
Respiratory Disease
Respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) are a
significant public health burden in the United States. Asthma and COPD are among the 10 leading
chronic conditions causing restricted activity. After chronic sinusitis, asthma is the most common
cause of chronic illness in children. COPD, which includes emphysema and chronic bronchitis, is
the fourth leading cause of death in San Diego County and the US. In 2007, COPD accounted for
1,023 deaths in San Diego County and 123,311 deaths nationally for an age-adjusted mortality
rate per 100,000 population of 34.1 and 40.5, respectively24.
Hospitalized Patients Smoking Cessation Study
A total of 126 participants were included in the pilot randomized control trial to assess how best
to assist hospitalized smokers quit smoking. This study is a partnership with the California Smokers
Helpline. The smoking cessation pilot and expanded study are prevention programs related to
respiratory disease considering the Respiratory Therapists are core to the pilot as well as the larger
NIH study. Many of the hospitalized smokers are admitted for pulmonary and respiratory disease
that is of course linked to smoking. (Sponsored by Scripps Mercy Hospital Chula Vista).
Partnership for Smoke-Free Families Program
Second-hand smoke is clearly a community health risk attributing to low birth weight in newborns,
Sudden Infant Death Syndrome (SIDS), respiratory infections, asthma and middle-ear disease
in infants and children. The Partnership for Smoke-Free Families (PSF) is a collaborative effort
supported by Scripps, Sharp Healthcare and Children’s Hospital focused on improving the health
and well being of children by reducing their exposure to second-hand smoke. (Sponsored by Scripps
Health Community Benefits).
City Heights Wellness Center, “Healthy Homes and Asthma Trigger Night Forum”
The City Heights Wellness Center partnered with the Community Asthma Task Force (CAT Force).
Families with asthmatic children often face a number of challenges that can lead to anxiety, fear
or conflict. The forum presented ways for parents to learn to overcome obstacles and challenges
presented by their child’s condition and find ways to work with them to maintain a healthy and
positive living environment. Some of the topics that were presented included: Learning how to
get an Asthma Action Plan completed by a doctor; learning how to have a school nurse and the
classroom teacher follow the Asthma Action Plan; learning how to rid homes of mold, allergens
and other asthma triggers; learning what can be done in homes to help children from having
asthma attacks; and learning about qualifying to have homes or apartments renovated at no cost.
(Sponsored by Scripps Mercy Hospital, Community Benefit Services).
24 Community Health Improvement Partners (CHIP). Charting the Course VI 2010: A San Diego County Health Needs Assessment.
Retrieved from the World Wide Web: http://www.sdchip.org.
51
Oral Health
Oral Health in America: A Report of the Surgeon General, declares that “oral health is essential to
the general health and well-being of all Americans.” The report identifies huge disparities in the
oral health status of certain populations in the United States, including low-income families, those
living in rural communities, racial or ethnic minorities, children, the elderly and the developmentally
disabled. The 2005 California Oral Health Needs Assessment reported 54 percent of kindergartners
and 71 percent of third-graders have a history of tooth decay, and more than 25 percent of
elementary school children have untreated decay. A report card issued in 2010 by Children Now
gave California a D+ for health coverage and a D+ for oral health.
Those who suffer the worst oral health are found among the poor of all ages, with poor children
and poor older Americans particularly vulnerable. Identified barriers to care include: No perceived
need for oral care; public and policymakers placing a low priority on oral health and prevention
strategies; lack of access to dentists; low socio-economic status and/or lack of financial resources
to pay for care; inadequate reimbursement by government insurance programs and excessive
paperwork required for reimbursement; lack of providers trained to care for diverse populations,
very young children and people with special needs; and Medi-Cal beneficiaries being unaware that
dental benefits are included as part of their insurance plan25.
Project Dulce
Project Dulce addresses oral health issues with patients during counseling visits.
Demographic and community need information data presented throughout the body of this document are based upon the findings
of the 2010 Community Health Needs Assessment or the most recent San Diego County community health statistics (unless otherwise
indicated).
25 Community Health Improvement Partners (CHIP). Charting the Course VI 2010: A San Diego County Health Needs Assessment.
Retrieved from the World Wide Web: http://www.sdchip.org.
52
Fostering Volunteerism
Scripps believes that health improvement begins when community members take an active role in
making a positive impact on their community. For this reason, Scripps supports volunteer programs
for Scripps employees and affiliated physicians who want to help make even more of a difference
in the health of their community. The ScrippsAssists employee volunteer club is one avenue through
which Scripps matches the talents and interests of employees and physicians with community
needs. This includes, but is not limited to, mentoring partnerships with local schools and efforts to
provide free medical and surgical care to patients in need.
In addition to the financial community benefit contributions made during FY10, Scripps employees
and affiliated physicians contributed a significant portion of their personal time volunteering to
support Scripps-sponsored community benefit programs and services.
With close to 22,452 hours of volunteer time, the estimated dollar value of this volunteer labor
is $955,153.2126. This amount is not included in Scripps’ FY10 community benefit programs and
services total.
26 Calculation based upon an average hourly wage for the Scripps Health system plus benefits.
53
FIGURE 4:1
FY10 Scripps Community Health Services
by Operating Unit, $16,016,598
Scripps Mercy Hospital Scripps Memorial
Chula Vista Scripps System-wide Hospital Encinitas
$980,887 $1,410,198 $658,988
6% 9% 4%
Scripps Memorial
Scripps Medical Hospital La Jolla
Scripps Green
Foundation $1,412,548
Scripps Whittier Hospital
$11,856 9%
Diabetes Institute $440,415
0% 3%
$404,878
3%
Scripps Mercy Hospital
San Diego and Mercy Clinic
$10,696,826
67%
Community Health Services:
Includes prevention and wellness programs as well as other community health improvement
services (screenings, health education, support groups and health fairs and subsidized services)
supported by operational funds, grants and in-kind donations. Calculations based on cost less
direct offsetting revenue. Direct offsetting revenue includes any revenue generated by the activity
or program, such as payment or reimbursement for services provided to program patients.
Direct offsetting revenue does not include restricted or unrestricted grants or contributions that
the organization uses to provide community benefits. Community Health Services’ expenses have
increased substantially beginning in FY08 as Scripps does not offset for grants or contributions.
This is based on the IRS guidelines.
54
FIGURE 4:2
FY10 Scripps Community Health Services
by Health Issue, $16,016,598
Health Related Behaviors Infectious
$71,018 Disease
0.4% $46,761
Cardiovascular 0.3% Maternal
Disease Child Health
Diabetes
Cancer/Oncology $323,814 $366,571
$441,311 Mental Health
$1,241,321 2% 2.3%
2.8% $5,219,526
7.8%
32.6%
Substance Abuse
Access to Care and Tobacco Use
$7,865,381 $56,740
Weight Status,
49.1% 0.4%
Other Nutrition, Activity
$197,929 and Fitness
1.2% $186,226
1.2%
Community Health Services:
Includes prevention and wellness programs as well as other community health improvement
services (screenings, health education, support groups and health fairs and subsidized services)
supported by operational funds, grants and in-kind donations. Calculations based on cost less
direct offsetting revenue. Direct offsetting revenue includes any revenue generated by the activity
or program, such as payment or reimbursement for services provided to program patients. Direct
offsetting revenue does not include restricted or unrestricted grants or contributions that the
organization uses to provide community benefits. Community Health Services’ expenses have
increased substantially beginning in FY08 as Scripps does not offset for grants or contributions.
This is based on the IRS guidelines.
55
SCRIPPS CommUnIty HEALtH SERVICES:
ACtIVIty SUmmARy
FY10
FY10 COMMUNITY HEALTH IMPROVEMENT SERVICES
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Beach Area Community Court Program 32 32 $2,731 356
Blood Drives for the American Red Cross 0 1,342 $73,315 2,844
Blood Drives for the San Diego Blood 0 64 $2,910 102
Brain Injury Rehabilitation Conference: 0 202 $8,114 220
Beyond the Hospital
Breast Cancer Education and Support 18 2,244 $89,267 3,305
Breast Cancer Education to the Newly Diagnosed 0 300 $18,101 300
Breastfeeding Support Groups – 0 1,158 $94,442 2,364
Scripps La Jolla Community Benefit Services
Cancer Center Awareness and Educational Events 20 791 $60,779 885
Cancer Center Heredity and Cancer Genetic 120 2,223 $178,917 2,990
Counseling Program
Cancer Center Nutrition Program 0 251 $6,315 18
Cancer Center Outpatient Social Worker and Liaison 0 383 $24,737 375
Program
Cancer Center Registered Nurse Navigator Program 130 441 $26,067 200
Cancer Center Support Groups – 0 0 $2,648 30
Scripps Green Hospital
Cancer Center Transportation Program 120 207 $9,997 125
Cancer Control – Breast Cancer Diagnosis Project 0 1,689 $70,106 126
Cancer Control Clinics 0 21 $1,769 30
Cancer Detection Programs: Every Women Counts 0 6,361 $411,896 536
Cancer Support Services – 0 61 $4,966 73
Health Improvement Services
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue. This
figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives. Categories are broken down in alignment with the new Schedule H
990. Community building activities, bad debt and Medicare shortfall do not count as Community Benefits under the new Schedule H
990 but are still reportable outside the community benefit table.
56
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Cancer Support Services and Educational Materials 0 735 $61,367 1,037
Cardiac Risk Screenings 0 86 $5,483 100
Cardiac Treatment Center Group Exercise Programs 100 850 $36,569 3,008
City Heights Wellness Center – 153 3,600 $149,412 9,388
Community Health Education
City Heights Wellness Center – 0 62 $3,141 194
Health Care Support Services
City Heights Wellness Center – Health Care Support 0 3 $130 8
Services/Community Health Education
City Heights Wellness Center – Health Education 0 325 $16,434 1,015
City Heights Wellness Center – 20 146 $8,125 1,008
Mental Health Education Services
Community Health Education Classes – 45 123 $7,224 313
Scripps Coastal Medical Center
Community Health Education Programs 46 943 $58,983 916
Community Health Fairs – Scripps La Jolla 0 112 $7,025 110
Community Benefit Services
Community Health Fairs and Fall Prevention 0 46 $2,911 1,996
Concussion Education and ImPACT Testing 0 73 $3,002 400
CPR and Emergency Preparedness 0 645 $28,189 634
CPR Classes for Patients and Families of the 0 10 $574 40
Cardiac Treatment Center
Disaster Preparedness – San Diego County and 0 24 $2,048 1,005
National Community Support and Outreach
Education
Emergency Response Course & CPR/AED for the 0 29 $9,290 105
Professional Rescuer & Health Provider
Encinitas Community Benefit 12 1,149 $57,676 187,620
Encinitas Community Outreach and Immunizations 200 1,829 $72,764 405
Fiji Alliance 536 640 $77,571 2,000
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives. Categories are broken down in alignment with the new Schedule H
990. Community building activities, bad debt and Medicare shortfall do not count as Community Benefits under the new Schedule H
990 but are still reportable outside the community benefit table.
57
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Health and Safety Fair – 0 55 $3,375 550
Scripps Home Health Services
Health Education and Support Groups 12 137 $8,735 303
Heart Health – Scripps Home Health Services 0 12 $787 116
High School Sports Physicals 32 15 $596 500
Joint Replacement Class 0 12 $530 16
Juvenile Diabetes Research Foundation Walk 4 1,585 $120,599 2,500
McDonald Center Intervention 0 104 $5,051 610
McDonald Center Support Groups 0 2 $171 11,040
MCH Programs – Breast Health – 0 1,883 $28,093 6,666
Community Health Education
MCH Programs – Breast Health – 0 0 $0 3,948
Community-Based Clinical
Mercy Outreach Surgical Team 3,651 3,861 $467,931 589
National Depression Screening 0 11 $747 25
Nutrition Education Class 0 10 $441 49
Occupational Therapy and Occupational Therapy 0 1,558 $78,775 16
Assistant
Official Physical Therapy Sportsmed Crew for Susan 450 40 $1,916 6,000
G. Komen 3-Day For The Cure Breast Cancer Walk
Organ Transplant Support Groups 12 78 $10,177 595
Parent Connection 325 2,080 $58,556 10,223
Peri-natal Education Classes – Scripps La Jolla 26 804 $42,045 1,601
Community Benefit Services
Physical Therapy for Incontinence & Pelvic Pain – 0 12 $530 36
Education to Community
Prescription Drug Take-Back Day 0 120 $16,572 0
Prevention of Cardiovascular Disease – 0 14 $753 106
Scripps Home Health Services
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives. Categories are broken down in alignment with the new Schedule H
990. Community building activities, bad debt and Medicare shortfall do not count as Community Benefits under the new Schedule H
990 but are still reportable outside the community benefit table.
58
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Project Dulce 0 27,056 $237,318 10,401
Recertification CPR/AED for the Professional Rescuer 0 2 $504 1
and Health Care Provider
Rehabilitation Parkinson's Class and Stroke Exercise 50 700 $30,904 75
Scripps Green Hospital Medical Library 0 0 $297,341 0
Scripps Haiti Mission 720 2,552 $283,364 1,700
Scripps Memorial Hospital La Jolla Medical Library 0 2,125 $157,658 0
Scripps Mercy Community Based Health 0 0 $0 2
Improvement – Community Health Education
Scripps Mercy Hospital Chula Vista Senior Programs 0 1,540 $48,960 720
Scripps Mercy Hospital Chula Vista Youth Programs 0 1,396 $32,047 2,055
Scripps Mercy Hospital San Diego Medical Library 0 2,541 $238,154 0
Scripps Mercy Maternal and Child Health Programs – 0 342 $9,923 255
Community Health
Scripps Mercy Maternal and Child Health Programs – 0 8,478 $246,246 6,328
Health Care Support
Scripps Polster Breast Care Center College Health 0 48 $5,446 700
Fairs
Scripps Polster Breast Care Center Education 25 46 $3,317 255
Seminars
Scripps Polster Breast Care Center Music as Medicine 12 10 $3,753 180
Program
Scripps Polster Breast Care Center Support Groups 240 154 $15,290 392
Scripps Recuperative Care Program 0 412 $79,822 26
Scripps Whittier Mobile Medical Unit (MMU) 10 627 $45,233 697
Seasonal Vaccines 0 4 $241 9
Senior Flu Shot Clinic 0 0 $0 400
SMH Nursing – Health Education 0 9 $543 241
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives. Categories are broken down in alignment with the new Schedule H
990. Community building activities, bad debt and Medicare shortfall do not count as Community Benefits under the new Schedule H
990 but are still reportable outside the community benefit table.
59
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
SMH Telecommunications – Health Care Support 0 0 $1,068 147
Services
STAR Communication Enhancement Group 0 67 $4,110 283
Stroke Care Programs 0 166 $7,490 551
Stroke Information and Blood Pressure Screenings 0 10 $603 96
TCOYD – SD Convention Center 0 32 $1,728 2,000
The START (Scripps Transition After Rehabilitation 30 1,200 $35,318 700
Treatment) Community Program
Trauma – Community Health Education 0 40 $3,414 0
Trauma – Community Health Improvement Services 0 4 $1,438 148
Trauma – Health Education 11 45 $2,614 98
Trauma – Health Improvement Services – 33 48 $26,108 3,006
Health Education
USS Mercy Hospital Ship 160 0 $0 450
Vitamins and Nutrition as you Age – 0 12 $656 106
Scripps Home Health Services
Wellness Expo 0 356 $22,352 350
Women, Infants, and Children (WIC) – 0 40,644 $1,840,906 108,158
Community Health Education
Women, Infants, and Children (WIC) – 0 130 $5,872 345
Community Support
Women's Health EXPO 16 1,375 $70,427 160
TOTAL FY10 COMMUNITY HEALTH 7,371 133,762 $6,301,545 412,705
IMPROVEMENT SERVICES
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives. Categories are broken down in alignment with the new Schedule H
990. Community building activities, bad debt and Medicare shortfall do not count as Community Benefits under the new Schedule H
990 but are still reportable outside the community benefit table.
60
FY10 SUBSIDIZED HEALTH SERVICES
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
In Lieu of Funds 0 0 $1,389,132 0
Subsidized Health Services 0 0 $7,417,175 0
TOTAL FY10 SUBSIDIZED HEALTH SERVICES 0 0 $8,806,307 0
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives. Categories are broken down in alignment with the new Schedule H
990. Community building activities, bad debt and Medicare shortfall do not count as Community Benefits under the new Schedule H
990 but are still reportable outside the community benefit table.
61
FY10 CASH AND IN-KIND DONATIONS
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
2-1-1 San Diego Annual Fundraising 0 0 $5,000 0
Adopt A Family – Scripps Memorial Hospital Encinitas 0 165 $9,051 32
Aloha Locks Cancer Wig Program 0 2,357 $182,616 3,000
Alpha Project 0 0 $1,000 0
American Heart Association Heart Walk 5,039 3,670 $178,635 2,500
American Heart Association Heart Walk – 0 0 $29,010 0
In-Kind Donation
American Heart Association Heart Walk – 0 0 $10,000 0
Sponsorship
CB Fund – 2-1-1 San Diego 0 0 $15,000 0
CB Fund – Catholic Charities 0 0 $40,000 150
CB Fund – Partnership for Smoke Free Families 0 0 $15,000 0
Community Benefit – Cash Donations 0 0 $7,500 0
Community Benefit – In-Kind Donations 0 0 $4,565 1,000
Consumer Center for Health Education and Advocacy 0 0 $120,000 0
(CCHEA)
Container Sponsorship Program: Haiti 0 0 $16,500 0
Donated Room Space for Not-For-Profit 0 0 $54,810 10,072
Organizations
Epilepsy Foundation of San Diego 0 0 $500 1,800
Monarch School Holiday Drive 0 6 $3,415 120
San Diego Museum of Man 0 56 $13,021 0
SMH MCH – In-Kind Donation 0 0 $2,000 0
Super Food Drive and San Diego Food Bank Event 2 106 $5,983 0
Susan G. Komen Race for the Cure 0 0 $5,000 0
Trauma – In-Kind Donation 0 10 $912 250
TOTAL FY10 CASH AND IN-KIND DONATIONS 5,041 6,370 $719,518 18,924
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives. Categories are broken down in alignment with the new Schedule H
990. Community building activities, bad debt and Medicare shortfall do not count as Community Benefits under the new Schedule H
990 but are still reportable outside the community benefit table.
62
FY10 COMMUNITY BENEFIT OPERATIONS
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Scripps Health System Community Benefit Planning 0 2,797 $189,229 0
and Outreach
TOTAL FY10 COMMUNITY BENEFIT OPERATIONS 0 2,797 $189,229 0
TOTAL FY10 COMMUNITY HEALTH SERVICES 12,412 142,929 $16,016,598 431,629
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives. Categories are broken down in alignment with the new Schedule H
990. Community building activities, bad debt and Medicare shortfall do not count as Community Benefits under the new Schedule H
990 but are still reportable outside the community benefit table.
63
FY10 COMMUNITY BUILDING ACTIVITIES
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
BHOP – Advocacy 0 2 $327 20
CHIP – Community Health Improvement Partners 0 510 $68,495 0
CHIP Committees and Work Teams – 0 60 $5,121 0
Scripps Mercy Hospital San Diego
City Heights Wellness Center – Coalition Building 0 584 $29,533 1,824
City Heights Wellness Center – Community Support 0 513 $25,939 1,617
City Heights Wellness Center – Health Advocacy 0 1,380 $23,614 1,345
Project (Leadership Development/Training)
Community Health Improvement Partners – 0 0 $5,245 0
CHIP Flight 15: Our Journey to Better Health
Fundraising Event
Disaster Preparedness – Community Outreach and 0 130 $14,023 219
Education
Economic Development – Community Building 0 466 $95,892 0
Health Care Reform and Legislative Advocacy 1 1,800 $402,424 0
LEAD San Diego Visionary awards 0 0 $5,000 800
Learning for Life San Diego – Imperial Council Boy 0 0 $5,000 0
Scouts of America
San Diego Nursing Service/Education Consortium 215 0 $1,300 600
Trauma – Coalition Building 0 28 $2,390 0
University of Southern California School of Policy, 0 0 $2,500 0
Planning and Development
YWCA Tribute to Women and Industry 0 0 $3,300 0
TOTAL FY10 COMMUNITY BUILDING ACTIVITIES 216 5,474 $690,103 6,425
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives. Categories are broken down in alignment with the new Schedule H
990. Community building activities, bad debt and Medicare shortfall do not count as Community Benefits under the new Schedule H
990 but are still reportable outside the community benefit table.
64
Professional Education and Health Research
Professional Education
and Health Research
“ The better a
doctor knows the culture
of the patients, the
better that
doctor will be.
– Mayra Dillon, MD ”
Mayra Dillon, MD, chief resident of the Scripps Family Medicine Residency, helped launch “Centering Pregnancy,” which reaches out to parents-to-be in
culturally sensitive ways.
Teaching Culturally Sensitive Community
Health Care
Mayra Mendoza Dillon, MD, chief resident of the Among the most important long-term benefits of
Scripps Family Medicine Residency program for the the program is the number of culturally-competent
2010 – 2011 academic year, is a Southern California physicians that it is producing.
native whose parents emigrated to the U.S. from
Mexico. Like dozens of other graduates from top “There are Latino cultural practices that you just don’t
American medical schools, she is completing her training learn in medical school. For example, Latinos favor
in the Scripps Family Medicine Residency program. traditional and alternative treatments, such as nopales,
a type of cactus, to treat diabetes. I know cactus alone
Half of the current residents in the program are won’t work, but I can be sensitive to my patients’ desire
members of underrepresented minorities, mostly to include cactus in their treatment plan,” explains
bilingual and bicultural Latinos. Of the 36 residency Dr. Dillion. “The better a doctor knows the culture of
graduates to date, 80 percent are providing primary their patients, the better the doctor will be at providing
medical care in San Diego County and more than quality guidance, like nutritional information centered
70 percent are practicing in designated areas of unmet on traditional Latino diets of tortillas, rice, beans, fruits
need in California. and vegetables.”
Dr. Dillion is particularly proud of “Centering By training in their patients’ homes, Scripps medical
Pregnancy,” a curriculum she helped launch in 2009. residents learn that they can’t just offer Latinos standard
“Prenatal care, which also includes fathers-to-be, is information about the traditional American food
something we strive to start very early in pregnancy,” pyramid, because they won’t follow it in their diets.
she says.
Kendra Brandstein, director of Community Benefit
This interactive prenatal education group teaches eight Services at Scripps Mercy Hospital Chula Vista
to 10 women and their partners about breastfeeding, campus, says, “The program has improved the cultural
stress in pregnancy, diet and exercise, domestic violence, competency of our health care providers so they can
and post-partum depression, among other topics. better understand the needs of the communities
they serve.”
“Centering Pregnancy has been a huge success,”
Dr. Dillion says. “The pregnant mothers have a wealth
of information to share with each other. They do most
of the talking and the clinicians act as group facilitators.
The bond between women is incredible.”
Section
Professional Education and
5 Health Research
Quality health care is highly dependent upon health education systems and medical research
programs. Without the ability to train and inspire a new generation of health care providers or to
offer continuing education to existing health care professionals, the quality of health care would
be greatly diminished. Medical research also plays an important role in improving the community’s
overall health through the development of new and innovative treatment options.
Each year, Scripps allocates resources to the advancement of health care services through clinical
research and medical education programs. During FY10 (October 2009 to September 2010),
Scripps invested $34,845,25427 in professional training programs and clinical research to enhance
service delivery and treatment practices for San Diego County. This section highlights some of our
professional education and health research activities.
Figure 5:1 page is a more detailed overview of the FY10 Scripps System Professional Education and
Health Research distribution. (Refer to Scripps System Professional Education and Health Research
Summary for an individual breakdown of each activity, page 66).
27 Reflects clinical research as well as professional education for non-Scripps employees, including graduate medical education, nursing
resource development, and other health care professional education. Research primarily takes place at Scripps Clinical Research Services,
Scripps Whittier Diabetes Institute, Scripps Genomic Medicine and Scripps Translational Science Institute. Calculations are based on total
program expenses less applicable direct-offsetting revenue. Expenses are not offset by grant revenue or restricted funds according to the
Schedule H 990 IRS guidelines.
65
FIGURE 5:1
Scripps Professional Education and Health Research
by Operating Unit, $34,845,25428
Scripps Whittier
Diabetes Institute
$620,575 Scripps Medical
Scripps Mercy Hospital 2% Foundation
Scripps Memorial Scripps Mercy Hospital
San Diego and Mercy Clinic $4,634
Hospital Encinitas Chula Vista
$7,495,167 0%
$441,468 $2,187,194
22%
1% 6%
Scripps Green
Hospital
$5,102,066
15%
Scripps Memorial
Hospital La Jolla
$731,356 Scripps System-Wide
2% $18,262,793
52%
Professional Education and Health Research:
This category reflects clinical research as well as professional education for non-Scripps employees,
including graduate medical education, nursing resource development and other health care
professional education. Research takes place primarily at Scripps Clinical Research Services,
Scripps Whittier Diabetes Institute, Scripps Genomic Medicine and Scripps Translational Science
Institute. Calculations are based on total program expenses less applicable direct-offsetting revenue.
Expenses are not offset by grant revenue or restricted funds according to the Schedule H 990
IRS guidelines.
28 Reflects clinical research as well as professional education for non-Scripps employees, including graduate medical education, nursing
resource development, and other health care professional education. Research primarily takes place at Scripps Clinical Research Services,
Scripps Whittier Diabetes Institute, Scripps Genomic Medicine and Scripps Translational Science Institute. Calculations are based on total
program expenses less applicable direct-offsetting revenue. Expenses are not offset by grant revenue or restricted funds according to the
Schedule H 990 IRS guidelines.
66
SCRIPPS SyStEm PRoFESSIonAL
EdUCAtIon And HEALtH RESEARCH SUmmARy
FY10
FY10 PROFESSIONAL EDUCATION
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Cancer Center Oncology Nursing Education Program 12 2,502 $138,867 1,014
ER – Professional Training – Other Educational 0 4,168 $176,618 502
Program
Exploratory Work Experience Educational Program 0 833 $48,894 38
Improving NICU Outcomes with Human Milk 10 86 $5,845 100
Joint Field Care Audit 0 10 $603 28
McDonald Center Education Program for Nursing 0 40 $3,414 1,040
Students
Nursing Student Education 56 697 $37,956 541
Physical Therapy and Physical Therapy Assistant 35 7,056 $310,405 143
Student Program
San Dieguito Academy WorkAbility Program 80 536 $27,487 100
Scripps High School Exploration Program 7,620 6,660 $148,913 35
Scripps Mercy Health Professionals Training 92 1,180 $37,541 473
Scripps Mercy Hospital Chula Vista Senior Programs – 89 236 $8,266 8
Other Professionals
Scripps Mercy Internal Medicine Residency Teaching 8 0 $0 100
Conference
Scripps Whittier Diabetes Institute Professional 12 4,630 $98,815 515
Education and Training
Speech Therapy and Speech Therapy Assistant 0 826 $50,664 7
Student Program
Student Preceptorship – Scripps Memorial Hospital 0 1,168 $75,134 24
La Jolla Cardiac Treatment Center
St. Vincent de Paul Village Medical center and 416 0 0 286
Mid-City Community Clinics
Student Preceptorship: Acute Rehab Nursing 0 170 $10,345 2
Trauma – Health Professions Education – Nursing 0 84 $4,431 226
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, etc.) associated with the program/service less direct revenue. This figure does
not include a calculation for physician and staff volunteer labor hours. In some instances, an entire community benefit program cost
center has been divided between several initiatives. Categories are broken down in alignment with the new Schedule H.
67
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Trauma – Health Professions Medical Education 60 0 $8,296 1,120
Trauma – Medical Education – Physicians 128 39 $20,474 2,383
Trauma – Other Health Professional Training 0 0 $407 55
Trauma – Professional Medical 20 0 $3,704 500
U.C. High School Exploration Program 700 0 $0 13
Work Force Development – Nursing and Non-Nursing 0 23,902 $1,442,118 1,378
TOTAL FY10 PROFESSIONAL EDUCATION 9,338 54,822 $2,659,198 10,631
FY10 HEALTH RESEARCH
Cancer Registry 0 17,266 $916,998 0
Clinical Research Services 0 205,099 $9,711,769 0
Community Health Research – Smoking Cessation 0 169 $4,903 126
Study Magnet Study
Research: College Suicide Prevention Magnet Study 0 190 $19,140 700
Research: Co-morbidities and Injury: Implications and 0 180 $6,902 0
Impact on Outcome on Trauma Patients
Research: Does the Changing Trauma Demographic 31 280 $9,698 0
Result in “Excess Mortality” Using Conventional
TRISS
Research: Effect of Specialty Training on Outcome of 51 42 $3,090 0
Operative Management of Extremity Vascular Trauma
Research: Impact of Crystalloids on the Development 62 275 $14,539 0
of Acute Lung Injury/ARDS in Resuscitation for
Research: Is the Difference in Trauma Patient 31 615 $22,876 0
Mortality Between the Insured and the Uninsured
Due to Co-Morbid Conditions?
Research: Repeat Head CT in Trauma Patients on 81 1,350 $62,506 0
Anticoagulants
Research: Resuscitation Outcomes Consortium (ROC) 0 10 $854 0
Study: EPISTRY
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, etc.) associated with the program/service less direct revenue. This figure does
not include a calculation for physician and staff volunteer labor hours. In some instances, an entire community benefit program cost
center has been divided between several initiatives. Categories are broken down in alignment with the new Schedule H.
68
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Research: ROC Prospective Observational 31 20 $1,707 0
Pre-hospital and Hospital Registry for Trauma Patient
(aka PROPHET)
Research: Role of Damage Control Resuscitation 31 200 $9,124 0
in the Perioperative Treatment Emergent Repair of
Ruptured Abdominal Aortic Aneurysms
Research: Study to Correlate Crash 31 140 $9,948 0
Research: Surveys in Support of Screening, Brief 0 20 $1,707 0
Intervention, and Referral to Treatment (SBIRT)
Research: Trauma Care Innovations and 35 1,350 $62,506 0
Quality of Care
Research: Trauma Peer Review and System Learning 62 155 $5,265 0
Research: Trial of Effectiveness of Screening and 31 30 $2,561 0
Brief Intervention for Drug Users in the Trauma and
Emergency Departments
Scripps Genomics Medicine and Translational 0 71,673 $7,485,114 0
Research
Scripps Mercy Hospital Chula Vista Youth Programs – 9 236 $6,980 155
Community Based
Scripps Mercy Maternal and Child Health Programs – 0 501 $14,554 374
Community Based
Scripps Whittier Diabetes Research 0 7,359 $511,075 0
Scripps Whittier Dulce Mothers 0 249 $10,685 209
TOTAL FY10 HEALTH RESEARCH 486 307,408 $18,894,500 1,564
FY10 GRADUATE MEDICAL EDUCATION
Scripps Clinic – Scripps Green Hospital 0 136,008 $5,068,906 0
Department of GME
Scripps Family Medicine Residency Program 0 55,696 $2,081,019 0
Scripps Mercy Hospital's GME Program 0 149,980 $6,141,631 0
TOTAL FY10 GRADUATE MEDICAL EDUCATION 0 341,684 $13,291,556 0
TOTAL FY10 PROFESSIONAL EDUCATION 9,824 703,915 $34,845,254 12,195
and HEALTH RESEARCH
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, etc.) associated with the program/service less direct revenue. This figure does
not include a calculation for physician and staff volunteer labor hours. In some instances, an entire community benefit program cost
center has been divided between several initiatives. Categories are broken down in alignment with the new Schedule H.
69
Scripps Memorial Hospital La Jolla
“ The friends we’d made through
The Parent Connection overwhelmed us
with kindness and grace.
”
Scripps Memorial
Hospital La Jolla
– Wyomi Yonzon-Yockey
Wyomi, George, Sydney, Logan and Hudson Yonzon-Yockey have both donated and received help through The Parent Connection, a nonprofit parenting
support network administered through Scripps Memorial Hospital La Jolla.
A Parent’s Connection To Scripps
When Wyomi Yonzon-Yockey and her young, vibrant She takes a deep breath. “You don’t realize until you’re
family moved to San Diego from Chicago in 2001, they in the middle of it how many expenses you face when
had no established network of friends. An acquaintance you lose a child. In an already devastating time, there is
recommended The Parent Connection, a nonprofit also an immediate crush of financial demands.”
parenting support network sponsored by
Scripps Memorial Hospital La Jolla. Recognizing the rare but real need to help families like
the Yonzon-Yockeys, The Parent Connection board
Wyomi quickly started a playgroup for neighborhood established Madison’s Fund, which provides critical
children and found close friends and kindred spirits in financial support to parents suffering the greatest
the community. Through the years she became more loss of all.
deeply involved in the group’s work, joining The Parent
Connection board. During that period, she personally “Luckily, we haven’t had to distribute money from
headed up fundraising for a financial assistance program Madison’s Fund recently, but 2011 marks the fund’s
initially established to help families devastated by the fifth anniversary, and sadly, it has been used. Knowing
2003 San Diego wildfires. that Madison’s Fund is there for other families is a great
comfort to me.”
At the time of her board service, Wyomi had no idea
that her family would also find itself in need of support. As the family continues to grow, Wyomi’s connection to
“In 2006, our daughter, Madison, drowned,” Wyomi Scripps remains strong. Her twin boys, now 20 months
remembers. “The friends we’d made through Parent old, were born at Scripps La Jolla in 2009. “It dawned
Connection overwhelmed us with kindness and grace. on me, rocking them late one night in the neonatal
We received letters from people in the group we’d ICU,” says Wyomi. “I was sitting in a chair The Parent
never met, telling us they were praying for us. Connection had donated to the NICU during my time
Parent Connection friends helped us through the on the board. That was a true ‘Circle of Life’ moment
worst of those days, bringing us meals, arranging for me. It’s been such an important part of our lives,
for cleaning, filling the house with flowers.” through good times and tough times, too. I know I’ll be
a lifetime member of this organization.”
Section
6 Scripps Memorial Hospital La Jolla
About Scripps Memorial Hospital (SMH) La Jolla
Located in the North Central region of San Diego County, Scripps Memorial Hospital (SMH) La Jolla
provides health care services to 21.0 percent of the inpatient population living within the hospital’s
50 percent service area. Today, the hospital has 357 licensed beds and more than 2,488 employees.
SMH La Jolla provides a wide range of clinical and surgical services including intensive care;
interventional cardiology and radiology; radiation oncology; cardiothoracic and orthopedic services;
neurology; ophthalmology; mental health and psychology services; as well as skilled nursing
services. As one of six designated trauma centers and one of nineteen emergency departments in
San Diego County, SMH La Jolla makes up a critical part of the county’s emergency service network.
Within the hospital’s service area, SMH La Jolla cares for 18.5 percent of Medicare patients,
6.4 percent of Medi-Cal patients, 25.4 percent of commercially insured patients and 20.4 percent
of patients with other payment sources including self-pay and charity care.
In addition to acute care services, a wide range of specialty services and programs are located on
the hospital’s campus, including the Cardiac Treatment Center, Imaging Center, Scripps Whittier
Diabetes Institute and Scripps Polster Breast Care Center.
Distinguishing Programs and Services
C
• rivello Cardiovascular Center
E
• mergency Department
G
• amma Knife Center of San Diego
N
• eonatal Intensive Care Nursery (operated by Children’s Hospital)
S
• cripps Polster Breast Care Center
S
• cripps Center for Women’s Health
S
• cripps McDonald Center
S
• cripps Mende Well Being Center
S
• cripps Mericos Eye Institute
S
• cripps Stevens Cancer Center (programs/services referenced in section 12)
T
• rauma Center
70
SCRIPPS mEmoRIAL HoSPItAL LA JoLLA
2011 CommUnIty BEnEFIt PLAn
FY11
The SMH La Jolla 2011 Community Benefit Plan provides a description of the overall Scripps
community benefit goal and the hospital’s objectives or/and strategies to support community health
services during Fiscal Year 2011 (October 2010 to September 2011).
Scripps’ 2011 Community Benefit Goal
Make a measurable impact on the health status of the community through improved access to care,
health improvement programs and professional education and health research.
SMH La Jolla’s FY11 Community Benefit Objectives
Community Health Services
Cancer Outreach, Education and Support
T
• he Polster Breast Care Center will offer a series of breast health education, support and
treatment programs including:
C
• ontinue to offer a Metastatic Support Group as an additional benefit to the existing
support services to the community.
• Continue to provide education and support services to those in the community
experiencing lymphedema as well as those who are at risk for lymphedema.
• Continue to provide education and support in breast health by participating in
community events and health fairs.
• Continue to support the volunteer Breast Buddy program, matching newly-diagnosed
breast cancer patients with a breast cancer survivor trained to be a mentor.
• Support Young Women’s Support Group bi-monthly meetings for woman under the age
of 40 in continuation of a Young Women’s Survivor Coalition (YSC), San Diego Chapter.
Funding assistance is given to YSC community education.
• Provide a Music as Medicine series designed to enhance the healing process for cancer
patients. This program is offered to the community at large and will be offered free of
charge to cancer patients and their loved ones.
Stevens Cancer Center
• Continue to offer risk assessment education to high-risk women for the BRCA genes
mutation free of charge.
• Provide education outreach to physicians on the genetic risks associated with breast and
ovarian cancer.
71
• Provide support services and community resources for health care workers, families,
caregivers and cancer patients.
• Provide counseling services and guidance regarding transportation, housing, homecare,
financial benefits, emotional concerns and other issues.
• Provide education outreach to physicians and patients on the genetic risks associated
with hereditary cancers.
• Continue to provide wig, head wrap and appearance programs with support from
Aloha Locks.
• In conjunction with rehabilitation services, continue to support education and exercise
classes focused on healing and recovery for our cancer patients.
• In conjunction with Scripps Whittier Diabetes Institute, continue to support education
and nutritional counseling for cancer treatment and recovery.
• Continue to work with community resources to develop patient cancer navigator role
and patient navigator education and resource notebook and distribute as appropriate.
• Continue to provide and develop evidence-based nursing continuing education
curriculum based on community needs assessment to include hospital staff as well as
ancillary offices and other nurses in the community.
• Continue to foster relationships and participate with professional organizations and
community outreach organizations at both the local and national level.
• Continue to foster academic affiliation and student support through preceptor
experiences.
• Plan and develop community-based informational and celebratory events specific to
patient populations and community needs.
• In conjunction with Community Health, participate in La Jolla events such as
Women’s Health Expo and the “Survivor” Breakfast and Luncheons.
• Provide community support and education through gynecological support group – twice
per month.
General Health Education and Wellness Initiatives
C
• ontinue to sponsor community-based support groups for Parkinson’s, infertility,
bereavement, breastfeeding, cardiac, cancer, ostomy, lymphedema, bariatrics, joint
replacement, ovarian cancer, multiple sclerosis, Compassionate Friends, mental health,
nutrition classes, Parkinson’s research, postpartum depression, Huntington’s, spine surgery,
chronic pain, parenting and grandparenting, CPR and babysitting safety and diabetes patients
at the Scripps Mende Well Being Center and at Scripps Memorial Hospital La Jolla.
P
• rovide meeting space at the Scripps Mende Well Being Center to community groups such as
Mothers of Twins, Parent Connection, Everyone a Reader, SD City Schools, SD County Social
Workers, Mental Health Alliance.
P
• rovide community CPR training courses at each of the Scripps Well Being centers located
throughout San Diego County.
72
O
• ffer a broad spectrum of health topics. Approximately 30 to 40 educational programs
on orthopedics, diabetes, osteoporosis, macular degeneration and other ophthalmological
conditions, women’s health issues, cancer, stroke, alternative and complimentary medicine,
heart health, exercise, nutrition, migraines, weight loss, incontinence and bladder health,
exercise and injury prevention, joint replacement, pain management, neurological disorders,
stress reduction, depression, hearing, dermatological, health care reform and urology
disorders.
C
• ontinue to provide smoking cessation program for all of SMH La Jolla’s in patients,
cardiac and pulmonary out patients, and staff.
C
• oordinate four blood drives on behalf of the American Red Cross at the SMH La Jolla
campus.
W
• ork with other non-profit community organizations such as American Heart Association,
the March of Dimes and the Susan G. Komen Foundation to promote healthy behaviors.
W
• ork with the Lawrence Family Jewish Community Center to offer 12 health education
seminars on a variety of health improvement topics focused on senior health issues.
P
• rovide health information and screenings (body fat and body mass index) at more than
three health events in San Diego County.
O
• ffer four vascular screening programs per year at SMH La Jolla Campus.
O
• ffer daily blood pressure checks through the kiosk program at the University Town Center
Mall.
A
• nnual Emergency Preparedness Expo for staff and community.
S
• upport school, Scripps nursing in-services at Mende Well Being, and community-based
medical outreach activities.
C
• ontinue to support and offer monthly nutrition education programs on three weight
management topics, pre-diabetes and eating tips for cancer patients.
C
• ontinue to offer a pregnancy healthy nutrition class for expectant women at least four times
per year.
O
• ffer on-going colorectal screening program.
O
• ffer four screenings per year for bone density and calcium scoring as risk indicators for
osteoporosis and heart disease.
S
• upport nursing school programs by offering student nurse observations of maternal child
health programs.
S
• upport Scripps Audit and Compliance updates by hosting monthly update meetings.
73
Heart Health/Cardiovascular Disease
E
• nhance cardiac health education and prevention efforts in the North Central Region of
San Diego County:
O
• ffer an education symposium targeting women helping to increase public awareness
about the advances in women’s health care.
O
• ffer four cardiac education programs for the community at large, focusing on current
heart treatment options and new screening technologies.
• Offer monthly cardiac screenings (blood pressure and body fat, lipid panel and cardiac
risk assessment) at SMH La Jolla.
• Offer cardiac screenings (blood pressure and body fat) at two to four health fairs located
throughout San Diego County.
• Coordinate two to four cardiac education programs at local colleges, businesses and
other locations.
• Offer a seven-week cardiac education class on a quarterly basis (four times) for newly
diagnosed patients, titled Straight to the Heart.
• Offer a continuous six week pulmonary education program.
• Offer a four-week stress management course on a quarterly basis (“Seven Steps to
Stress Mastery”).
• Offer a continuous education course for Cardiac Heart Failure (CHF) patients, titled
Taking Control of Heart Failure.
• Offer a continuous four-week exercise program for heart patients, titled Exercise for
Healthy Body.
• Provide monthly programs for heart patients including lectures, dinner, grocery store
tours, walks and social events through the Happy Hearts Club.
• Work with young women’s groups (sororities, civic clubs and volunteer organizations) to
provide heart health information, screenings, etc.
• Continue to hold the Cardiac Casino, providing education on heart health.
74
Maternal Child Health Education
• Continue to provide prenatal, postpartum and parenting education programs for low-income
women through out San Diego County.
• Offer a total of 165 Maternal Child Health classes throughout San Diego County
designed to enhance parenting skills. Low-income women in the County of San Diego
are eligible to attend all classes at no charge or on a sliding fee schedule.
• Maintain the existing prenatal education services in the county ensuring that programs
continued to demonstrate a more than 90 percent satisfaction rating.
• Continue to offer five breastfeeding support groups throughout the county on a weekly
basis (includes two with bilingual services).
• Offer 10 maternal child health education series covering issues such as grand parenting
and babysitter safety in San Diego County.
• Offer, Mommy and Me Yoga, Prenatal Yoga classes at the Scripps Mende Well Being.
O
• ffer quarterly Dogs and Babies Safety Education Program for expectant parents.
• Offer Pelvic Floor and Pregnancy Education Program for expectant women.
Substance Abuse Prevention and Treatment Programs
• Participate in at least one “Every 15 Minutes” event, targeting more than 400 high school
students.
• Scripps McDonald Center will offer a series of drug and alcohol abuse prevention and
treatment programs including:
• Continue providing county-wide lectures and respond to speaking requests from
the community.
• Promote awareness of the effects of alcoholism and chemical dependency, and
effective treatment.
• Maintain a speakers’ bureau able to accommodate requests for presentations on drug
abuse and prevention from community organizations throughout San Diego County.
• Offer monthly intervention trainings for persons suffering from addiction.
• Maintain and enhance web-based self-assessment tools for drug addiction, in addition
to a list of resources for care.
• Increase chemical dependency intervention and family systems education in the
community and continue to speak to parents and school systems.
• Offer drug and alcohol intervention workshops at no cost to parents of adolescents.
75
Unintentional Injury and Violence
• Provide at least two safety education programs for students and teachers on topics including
bike and skateboard safety and car seat safety.
• Provide at least two safety education programs for older adults.
Professional Education and Health Research
• Continue to function as a premier site for nursing clinical rotations for all nursing programs
in San Diego County; expand student exposure to outpatient and nontraditional patient
care areas.
• Provide preceptor experiences to nursing students in several nursing practice roles:
Educator, clinical specialist, manager, staff nurse.
• Continue to offer a robust student nurse extern program.
• Provide clinical education experiences for allied health students such as OT, PT, RCP,
radiographers, surgical technicians, clinical social workers, etc.
Uncompensated Health Care
S
• MH La Jolla will continue to provide health care services to vulnerable patients who are
unable to pay for services.
• Maintain, communicate and effectively administer Scripps’ financial assistance policy in
a manner that meets the needs of patients.
• Assure that care is available through the emergency department and trauma center,
regardless of a person’s ability to pay.
76
SCRIPPS mEmoRIAL HoSPItAL LA JoLLA
2011 CommUnIty BEnEFIt REPoRt
FY10
The SMH La Jolla Community Benefit Report is an account of the hospital’s dedication and
commitment to improving the health of the community, detailing the hospital’s programs
and services that have provided benefit over and above standard health care practices in
Fiscal Year 2010 (October 2009 to September 2010).
Fostering Volunteerism
In addition to the financial community benefit contributions made during FY10, SMH La Jolla
employees and affiliated physicians contributed a significant portion of their personal time
volunteering to support Scripps-sponsored community benefit programs and services. With close
to 1,837 hours of volunteer time, it is estimated that the dollar value associated with this volunteer
labor is $78,149.6729.
Making A Financial Commitment
During FY10, SMH La Jolla devoted $68,543,423 to community benefit programs and services
including uncompensated health care, community health services, professional education, and
health research. The programs offered by Scripps emphasize community-based prevention efforts
and use innovative approaches to reach residents at greatest risk for health problems.
FY10 Scripps Memorial Hospital La Jolla Community Benefit
Services Highlights
During FY10, SMH La Jolla contributed $68,543,423 to community benefits, including $7,958,129
in charity care, $11,404,303 in Medi-Cal and other means tested government programs,
$46,990,089 in Medicare shortfall, $46,998 in bad debt, $1,268,784 in community health services,
$143,764 in subsidized health services and $731,356 in professional education and research.
Refer to Figure 6:1 for a graphical representation of the FY10 Scripps Memorial Hospital La Jolla
Community Benefit Services distribution.
29 Calculation based upon an average hourly wage for the Scripps Health system plus benefits.
77
FIGURE 6:1
FY10 Scripps Memorial Hospital La Jolla
Community Benefit Services Distribution, $68,543,423
Subsidized
Community Health Services
Building Activities $143,764
0% 0.2%
Professional Education Bad Debt
and Health Research $46,998
0.1% Charity Care
$731,356 Medi-Cal and Other
$7,958,129
Community 1.1% Means-tested
11.6%
Health Services Government Programs
$1,268,784 $11,404,303
1.9% 16.6%
Medicare and
Medicare HMO
$46,990,089
68.6%
Community Benefit Services:
Community benefit services include those programs and services offered to the community that go
above and beyond what is provided as a normal part of patient care. Scripps categorizes community
benefit services in three categories, including uncompensated health care, community health
services and professional education and health research. Uncompensated care includes charity care,
bad debt, Medi-Cal and Other Means-Tested Government Programs and Medicare shortfalls.
78
SMH La Jolla’s FY10 Community Health Services
Community health services include prevention and wellness programs such as screenings, health
education, support groups and health fairs, which are supported by operational funds, grants,
in-kind donations and philanthropy. These programs are designed to raise public awareness,
understanding of and access to identified community health needs (refer to Section 2 – Assessing
Community Needs).
During FY10 (October 2009 to September 2010), SMH La Jolla invested $1,268,784 in community
health services. This figure reflects the cost associated with providing community health
improvement activities including salaries, materials and supplies, minus billable revenue. This section
highlights some of SMH La Jolla’s FY10 Community Health Services achievements.
SMH La Jolla’s FY10 Professional Education Highlights
Quality health care is highly dependent upon health education systems and medical research
programs. Without the ability to train and inspire a new generation of health care providers or to
offer continuing education to existing health care professionals, the quality of health care would be
greatly diminished.
Each year SMH La Jolla allocates resources to the advancement of health care services through
health professional education programs. To enhance service delivery and treatment practices for
San Diego County, SMH La Jolla invested $731,35630 in professional training programs during FY10
(October 2009 to September 2010). This section highlights some of SMH La Jolla’s professional
education activities conducted in FY10.
SMH La Jolla functioned as a clinical rotation site for nursing students in virtually all clinical areas
of the hospital. Provided support training and clinical rotations were provided in areas of the
hospital such as radiation oncology, cardiac treatment center, ICU, labor and delivery, Scripps
Polster breast care center, emergency department, operating room, etc. SMH La Jolla supported
clinical instruction and practice affiliations for non-nursing students: One-day student observations,
wound care lectures on the university’s campus, ICU learning lab three times per year. SMH La Jolla
also provided clinical and non-clinical experiences in rehab services, respiratory care, radiology,
cardiovascular lab, social services, food and nutrition services, executive health, lactation services,
and cardiac treatment center.
30 Reflects clinical research as well as professional education for non-Scripps employees nursing resource development and other health
care professional education. Calculations based on total program expenses.
79
SmH LA JoLLA CommUnIty BEnEFIt
SERVICES SUmmARy LISt
FY10
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Aloha Locks Cancer Wig Program 0 2,357 $182,616 3,000
Bad Debt** 0 0 $46,997 0
Beach Area Community Court Program 32 32 $2,731 356
Blood Drives for the American Red Cross 0 153 $7,576 399
Breast Cancer Education to the Newly Diagnosed 0 300 $18,101 300
Breastfeeding Support Groups – Scripps La Jolla 0 1,158 $94,442 2,364
Community Benefit Services
Cancer Center Awareness and Educational Events 20 791 $60,779 885
Cancer Center Heredity and Cancer Genetic 120 2,223 $178,917 2,990
Counseling Program
Cancer Center Nutrition Program 0 251 $6,315 18
Cancer Center Oncology Nursing Education Program 12 2,502 $138,867 1,014
Cancer Center Outpatient Social Worker and 0 383 $24,737 375
Liaison Program
Cancer Center Registered Nurse Navigator Program 130 441 $26,067 200
Cancer Center Transportation Program 120 207 $9,997 125
Cancer Control Clinics 0 21 $1,769 30
Cancer Support Services – 0 61 $4,966 73
Health Improvement Services
Cancer Support Services and Educational Materials 0 735 $61,367 1,037
Cardiac Risk Screenings 0 86 $5,483 100
Cardiac Treatment Center Group Exercise Programs 100 850 $36,569 3,008
Charity Care 0 0 $7,958,128 0
* “FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives.
**Community building activities, bad debt and Medicare shortfall do not count as community benefits under the new Schedule H 990
but are still reportable outside the community benefit table.
80
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Community Health Education Programs 46 943 $58,983 916
Community Health Fairs – Scripps La Jolla 0 112 $7,025 110
Community Benefit Services
Community Health Fairs and Fall Prevention 0 46 $2,911 1,996
CPR and Emergency Preparedness 0 645 $28,189 634
CPR Classes for Patients and Families of the Cardiac 0 10 $574 40
Treatment Center
Donated Room Space for Not-For-Profit 0 0 $8,984 1,462
Organizations
Health Education and Support Groups 12 137 $8,735 303
Improving NICU Outcomes with Human Milk 10 86 $5,845 100
In-Lieu-of Funds 0 0 $143,764 0
McDonald Center Education Program for 0 40 $3,414 1,040
Nursing Students
McDonald Center Intervention 0 104 $5,051 610
McDonald Center Support Groups 0 2 $171 11,040
Medicare and Medicare HMO** 0 0 $46,990,089 0
Nursing Student Education 56 697 $37,956 541
Nutrition Education Class 0 10 $441 49
Official Physical Therapy Sportsmed Crew for Susan 450 40 $1,916 6,000
G. Komen 3-Day For The Cure Breast Cancer Walk
Parent Connection 325 2,080 $58,556 10,223
Perinatal Education Classes – Scripps La Jolla 26 804 $42,045 1,601
Community Benefit Services
Physical Therapy and Physical Therapy Assistant 35 4,550 $200,874 135
Student Program
Rehabilitation Parkinson's Class and Stroke Exercise 50 700 $30,904 75
* “FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives.
**Community building activities, bad debt and Medicare shortfall do not count as community benefits under the new Schedule H 990
but are still reportable outside the community benefit table.
81
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
San Diego Museum of Man 0 56 $13,021 0
Scripps Memorial Hospital La Jolla Medical Library 0 2,125 $157,658 0
Scripps Polster Breast Care Center College Health 0 48 $5,446 700
Fairs
Scripps Polster Breast Care Center Education 25 46 $3,317 255
Seminars
Scripps Polster Breast Care Center Music as Medicine 12 10 $3,753 180
Program
Scripps Polster Breast Care Center Support Groups 240 154 $15,290 392
Stroke Information and Blood Pressure Screenings 0 10 $603 96
Student Preceptorship – Scripps Memorial Hospital 0 1,168 $75,134 24
La Jolla Cardiac Treatment Center
Unreimbursed Medi-Cal 0 0 $6,858,424 0
Unreimbursed Other Means-Tested Government 0 0 $4,545,873 0
Programs
Wellness Expo 0 356 $22,352 350
Women's Health EXPO 16 1,375 $70,427 160
Work Force Development – Nursing and 0 4,463 $269,266 228
Non-Nursing
TOTAL 1,837 33,366 $68,543,423 55,534
* “FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives.
**Community building activities, bad debt and Medicare shortfall do not count as community benefits under the new Schedule H 990
but are still reportable outside the community benefit table.
82
Scripps Memorial Hospital Encinitas
“ Scripps is an
opportunity
for our kids to get
great job experiences.
– Debra Brody, WorkAbility Coordinator ”
Hospital Encinitas
Scripps Memorial
During Greg Scribner’s shifts in the food and nutrition services department, he fills out menu cards for patients, preps food trays, delivers trays to patients’ rooms
and retrieves them when meal service is over.
WorkAbility: Ready, Willing, and Able to Excel
When the school bell peals at the end of the day at Through WorkAbility, students log about 30 hours
San Dieguito Academy, Greg Scribner doesn’t race off during the school year and are paid with WorkAbility
to the nearby beach to surf or head home to play video funds. They are evaluated at the end of the program
games. The 18-year-old eagerly walks the few blocks and, while there is no guarantee of employment at
to Scripps Memorial Hospital Encinitas, where he works Scripps, three students, including Greg, have applied for
every afternoon in the food and nutrition department. and gotten jobs.
Motivated, polite and sociable, Greg is never late and
never misses work. In 2010, 100 WorkAbility students participated at
Scripps Encinitas.
Greg’s job, which he loves, might not exist were
it not for Scripps’ participation in Workability, a Greg prepares a coffee cart to bring to family and
work experience program established in 1981 and friends visiting patients in the hospital. Throughout
administered by public school districts. his four-hour shift in the food and nutrition services
department, he also fills out menu cards for patients,
WorkAbility provides job and life skills training to preps food trays, delivers trays to patients’ rooms and
special education students like Greg, who have mild to retrieves them when meal service is over.
moderate disabilities. In the San Dieguito Union High
School District, more than 1,000 students from Carlsbad “I got training from employees at Scripps,” said Greg.
to Carmel Valley are involved in the program. “It took awhile to understand when it was time to
Debra Brody, the district’s WorkAbility coordinator, bring up the coffee cart or go pick up the menus, but
was eager to partner with Scripps Memorial Hospital everyone helped me a lot.”
Encinitas. Debra saw in Scripps a range of unique job
opportunities for her special education students that Debra said she knew Greg would be an ideal match
could not be rivaled anywhere else. for a role at Scripps.
“I wanted Scripps,” Brody said. “I’ve lived here over “Greg was sitting in the lobby, all dressed up for his
32 years, and I know from personal experience what interview, and along came a man on a gurney,” recalls
a fabulous hospital it is,” she said. “Scripps is an Debra. “Greg waved and smiled at him and the man just
opportunity for our kids to get great job experiences.” lit up. You can’t teach someone that.”
Section
7 Scripps Memorial Hospital Encinitas
About Scripps Memorial Hospital (SMH) Encinitas
Scripps Memorial Hospital (SMH) Encinitas, located along the coast of San Diego’s North County,
has 142 licensed beds, 1,424 employees and provides health care services to 24.4 percent of the
inpatient population living within the hospital’s North County West service area. SMH Encinitas
provides a wide range of acute clinical care services including, but not limited to, 24-hour
emergency services, intensive care, cancer/oncology, nuclear medicine, radiology, orthopedics,
neurology and urology. Within the hospital’s service area, SMH Encinitas cares for 25.7 percent
of Medicare patients, 19.2 percent of Medi-Cal patients, 26.0 percent of commercially-insured
patients, and 19.4 percent of patients with other payment sources, including self-pay and
charity care.
Distinguishing Programs and Services
• Ambulatory Surgery Center
• Comprehensive Perinatal Support Program
• Leichtag Women’s Health and Birth Pavilion
• Outpatient Rehabilitation Day Treatment Program
• Scripps Rehabilitation Center
• Spine Program
• Leichtag Family Birth Pavilion
• Outpatient Imaging Center and Kidney Dialysis
• Accredited Brain Injury Program
• Certified Primary Stroke Center
• Level II Neonatal Nursery
83
SCRIPPS mEmoRIAL HoSPItAL EnCInItAS
2011 CommUnIty BEnEFIt PLAn
FY11
The SMH Encinitas 2011 Community Benefit Plan provides a description of the overall Scripps
community benefit goal and the hospital’s objectives and strategies to support community health
improvement during Fiscal Year 2011 (October 2010 to September 2011).
Scripps’ 2011 Community Benefit Goal:
Make a measurable impact on the health status of the community through improved access to care,
health improvement programs, and professional education and health research.
SMH Encinitas’ FY11 Community Benefit Objectives
Community Health Services
O
• ffer more than 100 health education classes/seminars focusing on key health topics such
as heart disease, stroke, diabetes, medication management, skin cancer, ostomy care and
depression.
P
• rovide community rehabilitation programs (e.g. the Scripps Transition After Rehabilitation
Treatment [START] program) that offer counseling, crisis intervention, education, support
groups, exercise groups and communication enhancement groups to 1,800 people
throughout the North Coastal region of San Diego County.
H
• old two community conferences on PTSD and stress disorders resulting from brain injury
and other major illnesses and a brain injury conference.
O
• ffer an educational program for local high school students involved in contact sports.
T
• hrough the San Dieguito Academy WorkAbility Program, educate students and the
community regarding health care career opportunities. Provide first-hand tours of hospital
facilities and educate them on the complexities of hospital operations. The program is
designed to provide pre-employment skills training, worksite training and follow-up services
for youth (ages 12-22) with special needs who are making the transition from school to
work. While students get classroom training, Scripps has partnered with the program to
provide onsite training for the students. The goal is to expand the program system wide and
also introduce students with severe mental disabilities to the program in the near future.
H
• elp to distribute and administer doses of county (flu) vaccinations to high-risk populations
throughout San Diego County.
H
• old (5-6) Concussion Clinics (no charge) at area high schools. Sport activities leads to more
concussions than ever before, and repeat concussions can lead to brain damage.
84
Professional Education and Research
• Accommodate at least 35 students in the Exploratory Work Experience Education.
Uncompensated Health Care
• SMH Encinitas will continue to provide health care services to vulnerable patients who are
unable to pay for services.
• Maintain, communicate and effectively administer Scripps’ financial assistance policy in
a manner that meets the needs of patients.
• Assure that care is available through the emergency department, regardless of a
person’s ability to pay.
85
SCRIPPS mEmoRIAL HoSPItAL EnCInItAS
2011 CommUnIty BEnEFIt REPoRt
FY10
The SMH Encinitas Community Benefit Report is an account of the hospital’s dedication and
commitment to improving the health of the community, detailing the hospital’s programs
and services that have provided benefit over and above standard health care practices in
Fiscal Year 2010 (October 2009 to September 2010).
SMH Encinitas Fostering Volunteerism
In addition to the financial community benefit contributions made during FY10, SMH Encinitas
employees and affiliated physicians contributed a significant portion of their personal time
volunteering to support Scripps-sponsored community benefit programs and services. With close to
372 hours of volunteer time, it is estimated that the dollar value associated with this volunteer labor
is $15,825.6331.
SMH Encinitas Making A Financial Commitment
During FY10, SMH Encinitas devoted $41,480,539 to community benefit programs and services
including uncompensated health care, community health services, professional education and
health research. The programs offered by Scripps emphasize community-based prevention efforts
and use innovative approaches to reach residents at greatest risk for health problems.
FY10 Scripps Memorial Hospital Encinitas Community Benefit
Services Highlights
During FY10, SMH Encinitas contributed $41,480,539 to community benefits, including
$4,371,527 in charity care, $7,283,636 in Medi-Cal and Other Means Tested Government
Programs, $26,844,942 in Medicare shortfall, $1,879,977 in bad debt, $347,956 in community
health services, $311,033 in subsidized health services and $441,468 in professional education and
health research.
Refer to figure 7:1 for a graphical representation of the FY10 Scripps Memorial Hospital Encinitas
Community Benefit Services distribution.
31 Calculation based upon an average hourly wage for the Scripps Health system plus benefits.
86
FIGURE 7:1
FY10 Scripps Memorial Hospital Encinitas
Community Benefit Services Distribution, $41,480,539
Community
Building Activities
Professional Education 0%
and Health Research Bad Debt Medi-Cal and
$441,468 Subsidized $1,879,977 Other Means-tested
1.1% Health Services 4.5% Charity Care Government Programs
$311,033 $4,371,527 $7,283,636
0.7% 10.5% 17.6%
Community
Health Services
$347,956
0.8%
Medicare and
Medicare HMO
$26,844,942
64.7%
Community Benefit Services:
Community benefit services include those programs and services offered to the community that go
above and beyond what is provided as a normal part of patient care. Scripps categorizes community
benefit services in three categories, including uncompensated health care, community health
services, and professional education and health research. Uncompensated care includes charity
care, bad debt, Medi-Cal and Other Means-Tested Government Programs and Medicare shortfalls.
87
SMH Encinitas’ FY10 Community Health Services Highlights
Community Health Services improvement activities include prevention and wellness programs
such as screenings, health education, support groups and health fairs, which are supported by
operational funds, grants, in-kind donations and philanthropy. These programs are designed to
raise public awareness, understanding of and access to identified community health needs
(refer to Section 2 – Assessing Community Needs).
During FY10 (October 2009 to September 2010), SMH Encinitas invested $347,956 in community
health services. This figure reflects the cost associated with providing community health
improvement activities including salaries, materials and supplies, minus billable revenue.
This section highlights some of SMH Encinitas’ FY10 community health services.
SMH Encinitas’ FY10 Professional Education and Health Research Highlights
Quality health care is highly dependent upon health education systems and medical research
programs. Without the ability to train and inspire a new generation of health care providers or to
offer continuing education to existing health care professionals, the quality of health care would
be greatly diminished. Medical research also plays an important role in improving the community’s
overall health through the development of new and innovative treatment options.
Each year, SMH Encinitas allocates resources to the advancement of health care services through
health professional education programs. To enhance service delivery and treatment practices for
San Diego County, SMH Encinitas invested $441,46832 in professional training programs and
clinical research during FY10 (October 2009 to September 2010). This section highlights some of
SMH Encinitas’ professional education activities conducted in FY10.
• Accommodated 35 students in the Exploratory Work Experience Education program.
In partnership with the San Dieguito High School District and Carlsbad High School,
Scripps Memorial Hospital Encinitas provides students (juniors and seniors) with an
opportunity to observe professionals working in the health care environment. Students
are paired with a mentor in their area of interest and are given the opportunity to observe
hospital operations.
32 Reflects clinical research as well as professional education for non-Scripps employees, nursing resource development and other health
care professional education. Calculations based on total program expenses.
88
SmH EnCInItAS CommUnIty BEnEFIt
SERVICES SUmmARy LISt
FY10
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Adopt A Family - Scripps Memorial Hospital Encinitas 0 165 $9,051 32
Bad Debt** 0 0 $1,879,977 0
Drives for the American Red Cross 0 181 $11,486 354
Brain Injury Rehabilitation Conference: 0 202 $8,114 220
Beyond the Hospital, Into the Community
Breast Cancer Education & Support 18 1,407 $70,643 339
Charity Care 0 0 $4,371,527 0
Concussion Education and ImPACT Testing 0 73 $3,002 400
Encinitas Community Benefit 12 1,149 $57,676 187,620
Encinitas Community Outreach & immunizations 200 1,829 $72,764 405
Exploratory Work Experience Educational Program 0 833 $48,894 38
High School Sports Physicals 32 15 $596 500
In Lieu of Funds 0 0 $311,033 0
Medicare and Medicare HMO** 0 0 $26,844,942 0
Occupational Therapy and Occupational Therapy 0 1,558 $78,775 16
Assistant
Physical Therapy and Physical Therapy Assistant 0 2,506 $109,531 8
Student Program
Physical Therapy for Incontinence & Pelvic Pain - 0 12 $530 36
Education to Community
San Dieguito Academy WorkAbility Program 80 536 $27,487 100
Speech Therapy and Speech Therapy Assistant 0 826 $50,664 7
Student Program
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives.
**Community Building Activities, Bad Deb and Medicare Shortfall do not count as community benefits under the new Schedule H 990
but are still reportable outside the community benefit table.
89
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Student Preceptorship: Acute Rehab Nursing 0 170 $10,345 2
The START (Scripps Transition After Rehabilitation 30 1,200 $35,318 700
Treatment) Community Program
Unreimbursed Medi-Cal 0 0 $5,513,075 0
Unreimbursed Other Means-Tested 0 0 $1,770,561 0
Government Programs
Work Force Development – Nursing and Non-Nursing 0 3,224 $194,546 149
TOTAL 372 15,885 $41,480,539 190,926
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives.
**Community Building Activities, Bad Deb and Medicare Shortfall do not count as community benefits under the new Schedule H 990
but are still reportable outside the community benefit table.
90
Scripps Mercy Hospital
“ Through the years,
things that didn’t work. And then, there was this
I tried a lot of different
beautiful program called A-Visions.
– Rose “Posey” Hagerman, A-Visions candidate ”
Scripps Mercy Hospital
As a former nurse, Rose “Posey” Hagerman knows that most behavioral health patients don’t get the kind of support she receives through A-Visions.
A Vision of Success
In 1996, Brett Fogacci (seated above) was an art major Rose “Posey” Hagarman, who has lived with major
at University of California, San Diego. Then the voices depression most of her life, nevertheless became a
started. Diagnosed with paranoid schizophrenia, masters’-prepared surgical ICU nurse. “I was devastated
he struggled for years to come to terms with his illness. when I couldn’t continue that job after a stroke,”
“I didn’t accept that I was ill for several years,” Posey says. “Through the years I tried a lot of different
Brett says. things that didn’t work. And then, there was this
beautiful program called A-Visions. Some people are
Brett first came to Scripps Mercy Hospital during just dropped onto the street after their initial treatment.
a period of crisis and progressed from inpatient to But here, they lift you up.” After a year and a half in
outpatient care. Today, however, he isn’t at Mercy as a the program, Posey is currently pursuing her first paid
patient. Instead, Brett is hard at work providing clerical position.
support within the hospital to speed up the hospital’s
billing and reimbursement. Paid A-Visions candidates typically limit their work to
eight hours per week, which allows them to maintain
A-Visions, an innovative and nationally recognized their disability benefits, medications and medical care
supported work program, was launched in 2002 by that enable them to work.
Jerry Gold, PhD. Along with therapy, A-Visions
empowers people like Brett to secure volunteer or “Some candidates have lengthy commutes to work,”
paid employment within Scripps. Kevin reveals. “That’s how much they value what
they do.”
Kevin Wilson, the program lead, has been with A-Visions
since its inception and is the participants’ go-to resource “A-Visions has been a joy for me,” says Janice Shivers,
for guidance, coaching, and successes through the years. whose major depression has waxed and waned
“This program is client-focused and structured,” Kevin throughout her life. “I work part-time in health
explains. “It requires a consistent level of commitment information, and I love what I do. I just opened
and discipline from candidates.” After initial preparation a new bank account with my paycheck, and the teller
and coaching that can last several months, program said, ‘Oh, I love Scripps.’ It makes me feel so good to
participants begin working in volunteer roles. know that I’m a part of this organization. I’ve had my
job for four years – the longest I’ve ever worked any
one place.”
Section
8 Scripps Mercy Hospital
Scripps Mercy Hospital
With 700 licensed beds, more than 3,500 employees and 1,300 physicians; Scripps Mercy hospital
is San Diego’s longest-established and only Catholic medical center. With two campuses, Scripps
Mercy Hospital is San Diego County’s largest hospital. Scripps Mercy Hospital provides health care
services to 25.8 percent of the inpatient population living within the hospital’s Central services area.
Scripps Mercy is designated as a disproportionate share hospital providing care to a large number
of patients that either lack health insurance coverage or are covered through a government subsidy
program (30.3 percent are Medicare patients, 26.4 percent are Medi-Cal patients, 16.7 percent are
commercially insured patients, and 29.3 percent have another payment source including self-pay,
CMS and charity care).
San Diego Campus
Scripps Mercy Hospital is San Diego’s longest-operating and only Catholic hospital. Along with
its tradition of caring for the underserved population, Scripps Mercy Hospital features a shared
decision-making culture that encourages staff input and participation. Located in the Central
region of San Diego County, Scripps Mercy Hospital San Diego (Mercy) has 517 licensed beds
and 2,514 employees. As a major teaching hospital, Scripps Mercy Hospital provides a primary
site for the clinical education of more than 140 residents per year. Mercy hospital provides a wide
range of acute medical care services including, but not limited to, intensive care, cancer care,
cardiac treatment, endoscopy, neurology, nuclear medicine, orthopedics, radiology, rehabilitation,
respiratory care and urology services plus a variety of support services for low-income patients.
As one of six trauma centers and one of 19 emergency departments in San Diego County,
Mercy Hospital San Diego makes up a critical part of the county’s emergency service network.
Chula Vista Campus
Located approximately four miles from the United States—Mexico border in the South region of
San Diego County, Scripps Mercy Hospital Chula Vista has 183 licensed-care beds and more than
1,092 employees. It became a campus of Scripps Mercy Hospital in October 2004 and, together
with the Scripps Mercy facility in Hillcrest, the hospital is growing as needed to care for San Diego’s
Metro and South Bay communities Scripps Mercy Chula Vista provides a wide range of acute
clinical care services including, but not limited to, obstetrics and gynecology, rehabilitation
(physical, occupational and speech therapies), cancer care services, inpatient and outpatient
radiology, neurology and a full range of surgical services (orthopedic, thoracic/vascular, urology
and general surgery).
91
Distinguishing Programs and Services Distinguishing Programs and Services
Mercy San Diego Mercy Chula Vista
• Bariatric Surgery Program B
• reast health outreach and education
• Behavioral Health Services services
• Robotics Program • Neonatal Intensive Care nursery
• Heart Care Center S
• an Diego Border Area Health Education
• City Heights Wellness Center Center (AHEC)
• Family Birth Unit C
• ultural competency and language
• Graduate Medical Education services
• Lithotripsy Y
• outh health careers development
• Mercy Clinic programs
• Robotic Surgery Program • Health education programs
• Maternal Child Health S
• cripps Family Practice Residency
• Neonatal Intensive Care Nursery Program
• Neurological Institute • Scripps outpatient imaging center
• Orthopedic Center • Scripps rehabilitation services
• Spiritual Care Services S
• cripps Mercy Hospital Chula Vista
• Trauma Center Well Being Center
W
• IC (Women, Infants and Children)
Program
Subsidized Health Services
Subsidized health services are clinical programs that are provided despite a financial loss so
significant that negative margins remain after removing the effects of charity care, bad debt and
Medi-Cal shortfalls. Nevertheless, the service is provided because it meets an identified community
need and if no longer offered, it would either be unavailable in the area or fall to the responsibility
of government or another not-for-profit organization to provide.
Subsidized services do not include ancillary services that support lines, such as lab and radiology
(if these services are provided to low-income persons, they are reported as charity care/financial
assistance).
The total expense for subsidized health services for FY10 was $8,806,307. This includes Scripps
inpatient and outpatient behavioral health services, Mercy Clinic and Scripps In-Lieu of Funds.
Scripps offers both inpatient and outpatient adult behavioral health services at the Scripps Mercy
Hospital San Diego campus. Scripps Mercy’s Behavioral Health program also actively supports
community programs designed to reduce the stigma of mental illness and help affected individuals
live and work in the community.
92
Behavioral Health Inpatient Programs
Individuals suffering from acute psychiatric disorders are sometimes unable to live independently
or may even pose a danger to themselves or others. In such cases, hospitalization may be the most
appropriate alternative. Scripps Mercy Hospital’s Behavioral Health Inpatient Program helps patients
and their loved ones work through short-term crises, manage mental illness and resume their
daily lives.
Challenges
L
• ike many behavioral health programs across the country, funding is difficult,
as payment rates have not kept pace with the cost to provide care.
• In 2010, Scripps Mercy’s Behavioral Health Program lost $5.1 million.
• In 2010, 20 percent of patients in the inpatient unit were uninsured.
Behavioral Health Outpatient Programs
Scripps Mercy provides community-based adult psychiatric treatment at Scripps Mercy San Diego.
The outpatient program is an intensive day program designed to help individuals reduce their
symptoms while they continue to live in the community.
The program provides two levels of care:
• The outpatient program offers patients one to four treatment days per week.
T
• he partial hospitalization program provides more intensive treatment five to
six days per week.
A-Visions Program
T
• he innovative A-Visions Vocational Training Program, located at the San Diego campus,
helps prepare patients for volunteer and employment opportunities by giving them exposure
to a variety of work activities and training. The total expense for the A-Visions program for
FY10 was $84,774.
C
• urrently, 54 individuals are enrolled including eight as volunteers and 16 as Scripps Mercy
Hospital employees.
In-Lieu of Funds
In-Lieu of Funds are used for unfunded or underfunded patients and their post-discharge needs.
Funds are used for board and care, skilled nursing facilities, long-term acute care and home health.
In addition, funds are used for medications, equipment and transportation service. The total
subsidized expense for In-Lieu of Funds during FY10 was $1.4 million.
93
Mercy Clinic of Scripps Mercy Hospital San Diego
Founded in 1930 and adopted by the Sisters of Mercy in 1961, Mercy Clinic of Scripps Mercy
Hospital is a primary care clinic that treats more than 2,000 patients each month. Total patient visits
for primary and subspecialty care at the clinic in FY10 were 15,272. Established with the intent
of caring for the poor, Mercy Clinic has become a critical source of medical care for San Diego’s
“working poor.” Each year, eighty percent of the patient visits are paid through Medi-Cal, Medicare
or some other insurance plan. The remaining 20 percent pay what, and if, they can. Thousands of
people in the region rely on Mercy Clinic, most are low-income, medically underserved adults and
seniors who otherwise would have no other access to health care. The total subsidized expense for
Mercy Clinic for FY10 was $2.2 million (excludes Medicare, Medi-Cal, bad debt and charity care).
A full-time clinic staff of nurses and other personnel work hand-in-hand with physicians from
Scripps Mercy Hospital. As an integral part of treating its patients, Mercy Clinic serves as a training
ground for more than 50 residents each year from the Scripps Mercy Hospital Graduate Medical
Education Program. Note: Mercy Clinic expenses are included within Scripps Mercy Hospital
financials.
94
FIGURE 8:1
FY10 Scripps Subsidized Health Services Distribution
by Category, $8,806,307
In-Lieu of Funds
A-Vision Program $1,389,132 Mercy Clinic
$84,775 16% $2,223,011
Mercy Outpatient 1% 25%
Behavioral Health
$2,299,055
26%
Mercy Inpatient Behavioral
Health
$2,810,335
32%
Subsidized Health Services:
Subsidized Health Services are clinical programs that are provided despite a financial loss so
significant that negative margins remain after removing the effect of charity care, bad debt and
Medi-Cal shortfalls. This includes Scripps inpatient and outpatient behavioral health services,
Mercy Clinic, In-Lieu of Funds and the A-Visions Program.
95
SCRIPPS mERCy HoSPItAL SAn dIEGo
2011 CommUnIty BEnEFIt PLAn
FY11
The Scripps Mercy Hospital San Diego and Mercy Clinic 2011 Community Benefit Plan provides a
description of the overall Scripps community benefit goal and the hospital’s and clinic’s objectives
and strategies to support community health improvement during Fiscal Year 2011 (October 2010 to
September 2011).
Scripps’ 2011 Community Benefit Goal:
Make a measurable impact on the health status of the community through improved access to care,
health improvement programs, and professional education and health research.
Scripps Mercy Hospital San Diego and Mercy Clinic’s FY11 Objectives
Community Health Services
M
• ercy Outreach Surgical Team (MOST) – Through volunteerism, provide reconstructive
surgeries to more than 400 children (under 18 years of age) with physical deformities
caused by birth defects or accidents in Mexico.
C
• ity Heights Wellness Center – In 2002, Scripps Mercy Hospital and Rady Children’s
Hospital came together with the community to develop the City Heights Wellness Center.
The mission of the Wellness Center has been the promotion of health in the Mid-City region
of San Diego. The goal of the Wellness Center has been to prevent disease, strengthen
community partnerships, link with existing services and provide opportunities for city
residents to get involved in managing their own health. The continuing vision for the center
is to achieve optimal health and safety for the residents of City Heights.
The center uses a combination of approaches to address a broad array of community health
priorities, including nutrition, access to services and community engagement. The “hub”
of the Wellness Center is a teaching kitchen; a hands-on interactive setting for cooking
demonstrations, weight management and meal preparation classes, nutrition education and
counseling. Key objectives for 2011 will be to:
P
• romote healthy behaviors and positive health outcomes through educational
activities and community projects.
P
• rovide the most current and reliable health education and information consistent
with local language and cultural preferences.
W
• ork with local schools, community groups, businesses and other entities to increase
access to healthy foods and opportunities for physical activities in the City Center
Heights neighborhoods.
96
Co-located in the City Heights Wellness Center is the Scripps Mercy WIC, a federally funded
nutrition program targeting pregnant and parenting women and their children from ages 0 to 5
years. The Scripps Whittier Institute’s Project Dulce program utilizes the teaching kitchen at the
Wellness center to provide diabetes management services to community residents in order to
educate and improve dietary practices for individuals dealing with chronic health conditions.
In addition, the Wellness Center has received a contribution grant from The California Endowment
Foundation to continue its’ work with women and youth within the East African immigrants
population to improve dietary practices among youth and adults as they transition into American
culture; and to educate and improve knowledge, attitudes and behaviors in prevention strategies
and health access. The primary objectives in 2011 will be to:
P
• rovide community-based leadership training to address local policy issues that affect
the food environment and/or safety of residents in the City Heights area of San Diego.
P
• rovide education and advocacy support to local community groups to execute target
projects and initiatives aimed at health improvement.
W
• IC Services – Provide nutrition education, counseling services and food vouchers to a
minimum of 9,000 low-income women, infants and children monthly. Lactation education
and support services are offered to improve breast feeding among postpartum and
parenting women. The goal will be to improve breast feeding rates among low-income
postpartum and parenting women.
M
• ercy Clinic – Through the Mercy Clinic, provide preventive and primary health care service
visits, including adult medicine and women’s health.
• Increase Awareness of Mental Health and Geriatric Psychiatric Issues – Improve
awareness of mental health and geriatric psychiatric issues by providing information and
support services at community events.
• Improve services offered to the public during National Depression Screening Day by:
• Increasing the number of people assessed, educated and referred to services.
• Improving resource lists specific to region, levels of care and provider groups
Community Education – Continue to provide the community with education and awareness
regarding mental illness in an effort to reduce stigma and expand resources to the mentally ill.
Provide at least one in-service per month.
• articipate in at least three Every 15 Minutes events, targeting more than 1,000 high
P
school students in San Diego County.
P
• articipate in the Corrective Behavior Institute’s Youthful Drinking and Driving Program,
providing more than 100 teens with a trauma center visitation experience.
I
• ncrease the availability of injury prevention services (e.g., suicide prevention) throughout
San Diego County.
97
Professional Education and Health Research
Continue to serve as training site for Scripps Mercy Hospital San Diego and Chula Vista Graduate
Medical Education residents, U.C. San Diego Medical Students and Residents, and San Diego
Naval Hospital clinicians as indicated below:
P
• rovide comprehensive graduate medical education training for thirty-three internal
medicine residents; 18 Transitional Year residents and three chief residents.
P
• rovide comprehensive graduate medical education training for seven podiatry
residents.
P
• rovide a portion of graduate medical education training for seven family medicine
residents from the Mercy Chula Vista Campus.
P
• rovide a portion of graduate medical education training for 10 U.C. San Diego
pediatric residents and twelve U.C. San Diego internal medicine residents,
P
• rovide a portion of undergraduate medical education training for approximately
75 University of California San Diego third- and fourth-year medical students.
P
• rovide a comprehensive graduate medical education program in trauma and surgical
critical care for 62 San Diego Naval Hospital surgery and emergency medicine physicians.
P
• rovide a comprehensive didactic and clinical nursing education program in trauma care for
eight San Diego Naval Emergency Department nurses.
P
• rovide a comprehensive training program in trauma and critical care for 10 San Diego
Naval Hospital physicians assistants-in-training.
Uncompensated Health Care
Scripps Mercy Hospital San Diego and Mercy Clinic will continue to provide health care services to
vulnerable patients who are unable to pay for services.
• Maintain, communicate and effectively administer Scripps’ financial assistance policy in a
manner that meets the needs of patients.
• Assure that care is available through the emergency department and trauma center, regardless
of a person’s ability to pay.
98
SCRIPPS mERCy HoSPItAL SAn dIEGo
2011 CommUnIty BEnEFIt REPoRt
FY10
The Scripps Mercy Hospital San Diego Community Benefit Report is an account of the hospital’s
dedication and commitment to improving the health of the community, detailing the hospital’s
programs and services that have provided benefit over and above standard health care practices in
Fiscal Year 2010 (October 2009 to September 2010).
Fostering Volunteerism
In addition to the financial community benefit contributions made during FY10, Scripps Mercy
Hospital employees and affiliated physicians contributed a significant portion of their personal time
volunteering to support Scripps-sponsored community benefit programs and services. With close
to 4,561 hours of volunteer time, it is estimated that the dollar value associated with this volunteer
labor is $194,034.1133.
Making a Financial Commitment
During FY10, Scripps Mercy Hospital San Diego and Mercy Clinic devoted $86,000,449 to
community benefit programs and services, including uncompensated health care, community health
services, professional education and health research. The programs offered by Scripps emphasize
community-based prevention efforts and use innovative approaches to reach residents at greatest
risk for health problems.
FY10 Scripps Mercy Hospital San Diego and Mercy Clinic Community Benefit Services Highlights
During FY10, Mercy San Diego and Mercy Clinic contributed $86,000,449 to community benefits,
including $21,608,027 in charity care, $28,470,715 in Medi-Cal and Other Means Tested
Government Programs, $12,833,957 in Medicare shortfall, $4,808,833 in bad debt, $2,921,108 in
community health services, $7,495,167 in professional education and health research, $7,775,718
in subsidized health services and $86,923 in community building activities.
Refer to Figure 8:2 presented on the following page for a graphical representation of the FY10
Scripps Mercy Hospital San Diego and Mercy Clinic Community Benefit Services distribution.
33 Calculation based upon an average hourly wage for the Scripps Health system plus benefits.
99
FIGURE 8:2
FY10 Scripps Mercy Hospital San Diego and Mercy Clinic
Community Benefit Services Distribution, $86,000,449
Professional Education
and Health Research Subsidized Health
Charity Care
$7,495,167 Services
Medicare and $21,608,027
9% $7,775,718
Medicare HMO 25%
9%
$12,833,957 Community
15% Building Bad Debt
Activities $4,808,833
Community
$86,923 6%
Health Services
0%
$2,921,108
3%
Medi-Cal and Other
Means-tested Government
Programs
$28,470,715
33%
Community Benefit Services:
Community benefit services include those programs and services offered to the community that go
above and beyond what is provided as a normal part of patient care. Scripps categorizes community
benefit services in three categories, including uncompensated health care, community health
services and professional education and health research. Uncompensated care includes charity care,
bad debt, Medi-Cal and Other Means Tested Government Programs and Medicare Shortfalls.
100
Scripps Mercy Hospital San Diego and Mercy Clinic’s FY10 Community
Health Services
Community health services activities include prevention and wellness programs such as screenings,
health education, support groups and health fairs, which are supported by operational funds,
grants, in-kind donations and philanthropy. These programs are designed to raise public awareness,
understanding of and access to identified community health needs (refer to Section 2 – Assessing
Community Needs).
During FY10 (October 2009 to September 2010), Scripps Mercy Hospital and Mercy Clinic invested
$2,921,108 in community health services. This figure reflects the cost associated with providing
community health improvement activities, including salaries, materials and supplies, minus
billable revenue. This section highlights some of Scripps Mercy Hospital’s and Mercy Clinic’s FY10
community health services achievements.
Scripps Mercy Hospital San Diego and Mercy Clinic’s FY10 Professional
Education and Health Research Highlights
Quality health care is highly dependent upon health education systems and medical research
programs. Without the ability to train and inspire a new generation of health care providers or to
offer continuing education to existing health care professionals, the quality of health care would
be greatly diminished. Medical research also plays an important role in improving the community’s
overall health through the development of new and innovative treatment options.
Each year, Scripps Mercy Hospital San Diego and Mercy Clinic allocate resources to the
advancement of health care services through clinical research and medical education programs.
To enhance service delivery and treatment practices for San Diego County, Scripps Mercy Hospital
and Mercy Clinic invested $7,495,16734 in professional training programs and clinical research
during FY10 (October 2009 to September 2010). This section highlights some of Scripps Mercy
Hospital’s and Mercy Clinic’s professional education and research activities conducted in FY10.
Graduate Medical Education (GME) Program
Scripps Mercy Hospital San Diego is a major teaching hospital with the longest existing medical
education program in San Diego County. The program has been recognized nationally for its
impressive results and innovative curriculum. Founded in 1949, Scripps Mercy Hospital San Diego
and Mercy Clinic’s Graduate Medical Education program has served as training ground for more
than 1,000 future physicians, many of who have assumed leadership positions in the community.
There are currently 32 internal medicine residents and three chief residents enrolled in the program.
There are also 19 Transitional Year residents, 20 Family Medicine residents and seven Podiatry
residents enrolled in the program.
34 Reflects clinical research as well as professional education for non-Scripps employees, including graduate medical education, nursing
resource development and other health care professional education. Calculations based on total program expenses.
101
In 2006, the Internal Medicine Program at Scripps Mercy Hospital became one of 17 programs
nationwide to be invited to participate in a multi-year Educational Innovation Project, linking
measurable improvement in resident education to measurable improvement in patient care. In
2008, Scripps Mercy Hospital became the sponsor for the Accreditation Council on Graduate
Medical Education-Accredited Palliative Care Fellowship provided by San Diego Hospice and
the Institute for Palliative Care. That program provides a palliative care service to inpatients and
outpatients at Scripps Mercy Hospital. Since 1986, Scripps Mercy Hospital Trauma Services has
provided graduate medical education in trauma and critical care for the Naval Medical Center
(NMCSD) General Surgery Residency Program. In 1999, the Accreditation Council for Graduate
Medical Education Residency Review Committee for Surgery officially integrated Scripps Mercy with
the NMCSD General Surgery Residency Program. Today, the Trauma Service also provides training
opportunities to residents in several other programs, including: NMCSD Oromaxillofacial Surgery,
Otolaryngology, Emergency Medicine, and Transitional Year Residencies; Scripps Mercy Hospital
Transitional Year Residency; and Children’s Specialists of San Diego Pediatric Emergency Medicine
Fellowship. All these residents play a key role in managing and maintaining the continuity of care
for patients in the Central region.
In addition to providing medical services to indigent and unassigned patients at Scripps Mercy
Hospital, the residents and interns staff Mercy Clinic, Scripps Mercy Hospital primary care clinic.
With more than 20,000 patient contacts each year, Mercy Clinic provides adult care to underserved
patient populations as well as subspecialty care for clinic and community clinic patients. The clinic
participates in multiple projects to meet the needs of this population, including health screenings,
Breast Cancer Early Detection Program (BCEDP) and Project Dulce to name a few.
In 2009, the Hoover Health Clinic established a satellite relationship with the La Maestra Family
Health Center, which Hoover with the ability to provide a full scope of preventive and primary care
services. A team of La Maestra health professionals work along side the school Nurse Practitioners
in this setting 20 hours per work. Dr. Shaila Serpas, Faculty of the Scripps Family Practice Residency,
is working in partnership with La Maestra Family Health Clinic to fulfill the role of Medical Director
at the Hoover Clinic. This relationship provides benefits to all organizations involved: Hoover Health
Clinic has the capacity to provide primary health care to students and their family members beyond
the scope of routine school health services. Many of these youth, and family members, do not
have insurance and/or an on-going medical home for health care. Working under the auspice of
La Maestra allows Dr. Serpas to see Hoover Health Center patients under the community clinic
license and Family Practice Residents can choose clinical rotations in adolescent medicine at this
site. A continuum of care is offer to the Hoover patients, with follow up care available at
La Maestra, which is a short walking distance from the high school.
These inpatient and outpatient facilities provide residents and interns with an opportunity to
acquire knowledge and experience in a real-life setting, while providing primary care, specialty
102
services and tertiary care referrals to the Central region’s underserved populations. The FY10 cost
of operating the Scripps Mercy Hospital San Diego Graduate Medical Education program totaled
$6,141,63135.
Other Professional Education Training Programs
In FY10, Scripps Mercy Hospital San Diego and Mercy Clinic served as a training site for San Diego
Naval Hospital and UCSD clinicians as indicated below.
• Provided rotations to the Internal Medicine inpatient service for UCSD Internal Medicine
and Psychiatry residents, and medical students, as well as to the Mercy Clinic for Psychiatry
residents and medical students.
• Provided a comprehensive graduate medical education program in trauma and surgical critical
care for 62 San Diego Naval Hospital surgery and emergency medicine physicians.
• Provided a comprehensive didactic and clinic nursing education program in trauma care for
14 San Diego Naval Emergency Department nurses.
• Provided a comprehensive training program in trauma and critical care for 10 San Diego Naval
Hospital physicians assistants-in-training.
34 GME calculations based on total program expenses plus overhead.
103
SCRIPPS mERCy HoSPItAL And mERCy CLInIC
CommUnIty BEnEFIt SERVICES SUmmARy LISt
FY10
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Bad Debt** 0 0 $4,808,833 0
BHOP – Advocacy** 0 2 $327 20
Blood Drives for the American Red Cross 0 293 $19,851 579
Charity Care 0 0 $21,608,027 0
CHIP Committees and Work Teams – 0 60 $5,121 0
Scripps Mercy Hospital San Diego**
City Heights Wellness Center – Coalition Building** 0 584 $29,533 1,824
City Heights Wellness Center – 153 3,600 $149,412 9,388
Community Health Education
City Heights Wellness Center – Community 0 513 $25,939 1,617
Support**
City Heights Wellness Center – Health Advocacy 0 1,380 $23,614 1,345
Project (Leadership Development/Training)**
City Heights Wellness Center – 0 62 $3,141 194
Health Care Support Services
City Heights Wellness Center – Health Care Support 0 3 $130 8
Services/Community Health Education
City Heights Wellness Center – Health Education 0 325 $16,434 1,015
City Heights Wellness Center – 20 146 $8,125 1,008
Mental Health Education Services
Community Benefit – Cash Donations 0 0 $7,500 0
Community Benefit – In-Kind Donations 0 0 $4,565 1,000
Consumer Center for Health Education and Advocacy 0 0 $120,000 0
(CCHEA)
ER – Other Health Professional Training 0 10 $603 28
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives.
**Community Building Activities, bad debt and Medicare shortfall do not count as community benefits under the new Schedule H 990
but are still reportable outside the community benefit table.
104
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
In Lieu of Funds 0 0 $358,543 0
Joint Field Care Audit 0 4,168 $176,618 502
Medicare and Medicare HMO** 0 0 $12,833,957 0
Mercy Outreach Surgical Team 3,651 3,861 $467,931 589
National Depression Screening 0 11 $747 25
Research: College Suicide Prevention Magnet Study 0 190 $19,140 700
Research: Comorbidities and Injury: Implications and 0 180 $6,902 0
Impact on Outcome on Trauma Patients
Research: Does the Changing Trauma Demographic 31 280 $9,698 0
Result in “Excess Mortality” Using Conventional
TRISS
Research: Effect of Specialty Training on Outcome of 51 42 $3,090 0
Operative Management of Extremity Vascular Trauma
Research: Impact of Crystalloids on the Development 62 275 $14,539 0
of Acute Lung Injury/ARDS in Resuscitation for
Traumatic Hemorrhagic Shock
Research: Is the Difference in Trauma Patient 31 615 $22,876 0
Mortality Between the Insured and the Uninsured
Due to Co-Morbid Conditions?
Research: Repeat Head CT in Trauma Patients on 81 1,350 $62,506 0
Anticoagulants
Research: Resuscitation Outcomes Consortium (ROC) 0 10 $854 0
Study: EPISTRY
Research: ROC Prospective Observational Prehopsital 31 20 $1,707 0
and Hospital Registry for Trauma Patient (aka
PROPHET)
Research: Role of Damage Control Resuscitation in 31 200 $9,124 0
the Perioperative Treatment Emergent Repair of
Ruptured Abdominal Aortic Aneurysms
Research: Study to Correlate Crash 31 140 $9,948 0
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives.
**Community Building Activities, bad debt and Medicare shortfall do not count as community benefits under the new Schedule H 990
but are still reportable outside the community benefit table.
105
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Research: Surveys in Support of Screening, Brief 0 20 $1,707 0
Intervention, and Referral to Treatment (SBIRT)
Research: Trauma Care Innovations and 35 1,350 $62,506 0
Quality of Care
Research: Trauma Peer Review and System Learning 62 155 $5,265 0
Research: Trial of Effectiveness of Screening and 31 30 $2,561 0
Brief Intervention for Drug Users in the Trauma and
Emergency Departments
Scripps Mercy Hospital San Diego Medical Library 0 2,541 $238,154 0
Scripps Mercy Hospital's GME Program 0 149,980 $6,141,631 0
Scripps Mercy Internal Medicine Residency Teaching 8 0 $0 100
Conference
Seasonal Vaccines 0 4 $241 9
SMH MCH – In-Kind Donation 0 0 $2,000 0
SMH Nursing – Health Education 0 9 $543 241
SMH Telecommunications – 0 0 $1,068 147
Health Care Support Services
Subsidized Health Services 0 0 $7,417,175 0
Trauma – Coalition Building** 0 28 $2,390 0
Trauma – Community Health Education 0 40 $3,414 0
Trauma – Community Health Improvement Services 0 4 $1,438 148
Trauma – Health Education 11 45 $2,614 98
Trauma – Health Improvement Services – 33 48 $26,108 3,006
Health Education
Trauma – Health Professions Education – Nursing 0 84 $4,431 226
Trauma – Health Professions Medical Education 60 0 $8,296 1,120
Trauma – In-Kind Donation 0 10 $912 250
Trauma – Medical Education – Physicians 128 39 $20,474 2,383
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives.
**Community Building Activities, bad debt and Medicare shortfall do not count as community benefits under the new Schedule H 990
but are still reportable outside the community benefit table.
106
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Trauma – Other Health Professional Training 0 0 $407 55
Trauma – Professional Medical 20 0 $3,704 500
Unreimbursed Medi-Cal 0 0 $18,306,070 0
Unreimbursed other Means-Tested Government 0 0 $10,164,646 0
Programs
Women, Infants, and Children (WIC) – 0 40,644 $1,840,906 108,158
Community Health Education
Women, Infants, and Children (WIC) – 0 130 $5,872 345
Community Support
Work Force Development – Nursing and 0 15,026 $906,579 941
Non-Nursing
Total 4,561 228,507 $86,000,449 137,569
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives.
**Community Building Activities, bad debt and Medicare shortfall do not count as community benefits under the new Schedule H 990
but are still reportable outside the community benefit table.
107
SCRIPPS mERCy HoSPItAL CHULA VIStA
2011 CommUnIty BEnEFIt PLAn
FY11
The Scripps Mercy Hospital Chula Vista 2011 Community Benefit Plan provides a description of
the overall Scripps community benefit goal and the hospital’s objectives and strategies to support
community health improvement during Fiscal Year 2011 (October 2010 to September 2011).
Scripps’ 2011 Community Benefit Goal:
Make a measurable impact on the health status of the community through improved access to care,
health improvement programs, and professional education and health research.
Scripps Mercy Chula Vista’s FY11 Objectives
Youth Activities
To implement a wide variety of youth in health career activities including: Camp Scripps, mentoring
program, hospital tours, in-classroom presentations and surgery viewings. A total of 2,500 youth
will participate in these programs.
Community-Based Health Improvement Activities (Scripps Mercy Hospital Well-Being Center)
Each month approximately 450 to 500 community members will participate in classes, prevention
lectures and support groups held at the Center. A total of 5,000 participants will use the Center
classes and support groups.
Senior Programs
Each month a variety of senior programs will be held with local senior centers, churches and senior
housing. Some of these activities include: senior health chats, men's group, Senior Camp Scripps,
flu event, health fairs and a widow support group. A total of 1,000 seniors will participate in these
programs.
108
Cancer Programs
Women in Action: Breast Health Outreach and Education Program – A total of 3,800 women
will be referred to clinical breast health services in the community and Scripps Mercy Hospital
Chula Vista radiology services. A total of 9,000 services will be provided including telephone
reminders, outreach and education, case management and a variety of presentations.
Healthy Youth, Healthy Futures Cancer Prevention and Awareness Program – A total
of 450 youth will be provided educational activities to improve awareness of cancer and
early detection.
Senior Healthy Lifestyles: Cancer Prevention and Education Program – A total of 300 seniors
will participate in cancer focused community activities.
Hospitalized Patients Smoking Cessation Study – A total of 1,000 participants will be included
in the randomized control trial to assess how best to assist hospitalized smokers quit smoking.
Maternal and Child Health Programs
First 5 – More than 180 home visits will be provided. A total of 660 services will be given for first
time mothers including: home visits, referrals received, data entry, follow up phone calls, parenting
classes and other support services.
First 5 – A total of 320 parents will participate in parenting classes with 48 sessions held.
109
Professional Education and Research
Health Careers Promotion and Continuing Education (San Diego Border Area Health Education
Center (AHEC). The primary mission of the San Diego Border AHEC Program is to build and support
a diverse, culturally competent primary health care workforce in San Diego’s medically underserved
communities. Through this program it will improve health care access, education, job training and
placement for youth and adults in the South region of San Diego County.
Implement youth into health-focused career activities for youth. Activities will include mentoring,
camps, job shadowing, health education classes, health chats, support groups, health fairs as well
as a variety of other activities. Curriculum developed for youth into health careers.
• Expand community medicine opportunities for Family Practice Residents to provide services
and reach at least 1,000 individuals.
• Continue to work closely with Scripps Family Practice Residency Program to place medical
students in community health activities.
• A total of 500 health professionals will participate in community activities, internship
programs, residency rotations and Balint support groups.
Uncompensated Health Care
• Located near the United States Mexico border Scripps Mercy Chula Vista plays a pivotal role
in the health care delivery network for the underserved in San Diego County. During FY10,
Scripps Mercy Chula Vista will continue to provide health care services to vulnerable patients
who are unable to pay for services.
• Maintain, communicate and effectively administer Scripps’ financial assistance policy in
a manner that meets the needs of patients.
• Assure that care is available through the emergency department, regardless of a
person’s ability to pay.
110
SCRIPPS mERCy HoSPItAL CHULA VIStA
2011 CommUnIty BEnEFIt REPoRt
FY10
The Scripps Mercy Chula Vista Community Benefit Report is an account of the hospital’s dedication
and commitment to improving the health of the community, detailing the hospital’s programs
and services that have provided benefit over and above standard health care practices in
Fiscal Year 2010 (October 2009 to September 2010).
Fostering Volunteerism
In addition to the financial community benefit contributions made during FY10, Scripps Mercy
Chula Vista employees and affiliated physicians contributed a significant portion of their
personal time volunteering to support Scripps-sponsored community benefit programs and services.
With close to 190 hours of volunteer time, it is estimated that the dollar value associated with this
36
volunteer labor is $8,082.98 .
Making a Financial Commitment
During FY10, Scripps Mercy Chula Vista devoted $29,418,673 to community benefit programs and
services, including uncompensated health care, community health services, professional education,
and health research. The programs offered by Scripps emphasize community-based prevention
efforts and use innovative approaches to reach residents at greatest risk for health problems.
FY10 Scripps Mercy Hospital Chula Vista Community Benefit Services Highlights
During FY10, Scripps Mercy Chula Vista contributed $29,418,673 to community benefits, including,
$8,292,316 in charity care, $10,200,265 in Medi-Cal and Other Means Tested Government
Programs, $4,992,885 in Medicare shortfall, $2,765,126 in bad debt, $418,326 in community
health services, $562,561 in subsidized health services and $2,187,194 in professional education
and health research.
Refer to Figure 8:3 presented on the following page for a graphical representation of the FY10
Scripps Mercy Hospital Chula Vista Community Benefit Services distribution.
36 Calculation based upon an average hourly wage for the Scripps Health system plus benefits.
111
FIGURE 8:3
Scripps Mercy Hospital Chula Vista
Community Benefit Services, $29,418,673
Professional Education
Charity Care
and Health Research Subsidized
Medicare and $8,292,316
$2,187,194 Health Services
Medicare HMO 28.2%
7.4% $562,561
$4,992,885
1.9%
17% Bad Debt
Community Community $2,765,126
Health Services Building Activities 9.4%
$418,326 0%
1.4%
Medi-Cal and Other Means-tested
Government Programs
$10,200,265
34.7%
Community Benefit Services:
Community benefit services include those programs and services offered to the community that go
above and beyond what is provided as a normal part of patient care. Scripps categorizes community
benefit services in three categories, including uncompensated health care, community health
services and professional education and health research. Uncompensated care includes charity care,
bad debt, Medi-Cal and Other Means-Tested Government Programs and Medicare shortfalls.
112
Scripps Mercy Hospital Chula Vista’s FY10 Community Health Services
Highlights
Community health services activities include prevention and wellness programs such as screenings,
health education, support groups and health fairs, which are supported by operational funds,
grants, in-kind donations and philanthropy. These programs are designed to raise public awareness,
understanding of and access to identified community health needs (refer to Section 2 – Assessing
Community Needs).
During FY10 (October 2009 to September 2010), Scripps Mercy Chula Vista invested $418,326
in community health services. This figure reflects the cost associated with providing community
health improvement activities, including salaries, materials and supplies, minus billable revenue.
This section highlights some of Scripps Mercy Chula Vista’s FY10 community health services
achievements.
Scripps Mercy Hospital Chula Vista’s FY10 Professional Education and
Health Research Highlights
Quality health care is highly dependent upon health education systems and medical research
programs. Without the ability to train and inspire a new generation of health care providers or to
offer continuing education to existing health care professionals, the quality of health care would be
greatly diminished.
Each year Scripps Mercy Hospital Chula Vista allocates resources to the advancement of health care
services through professional health education programs. To enhance service delivery and treatment
practices for San Diego County, Scripps Mercy Chula Vista invested $2,187,19437 in professional
training programs during FY10 (October 2009 to September 2010). This section highlights some of
Scripps Mercy Chula Vista’s professional education and health research activities conducted in FY10.
36 Calculation based upon an average hourly wage for the Scripps Health system plus benefits.
113
Research Efforts
Proactive Intervention with Hospitalized Smokers: A randomized control trial.
2009-In-Progress, Funding Source: Scripps Clinical Research Development Award
• A total of 126 hospitalized smokers have been recruited for this study. More than
1,000 smokers were screened. Manuscripts are under development. An expanded study
was funded.
• California Border Healthy Start Evaluation. 2008 – A total of 300 participants were recruited
as part of the program. Several manuscripts are currently underway.
• Principal Investigator: Scripps Mercy Youth into Health Career Mentoring Program Evaluation.
2007 – Funding Source: The California Endowment. Several manuscripts are currently
underway.
• Program Development and Funding – A total of 19 proposals have been submitted
and approximately $500,000 in funding was received between FY09 and FY10 from a
combination of federal, state and private agencies. Multiple proposals have been prepared
for administration and other departments during this fiscal year.
Scripps Family Medicine Residency Program
The Scripps Family Medicine Residency Program (FMRP) is a community-based training program
developed through a partnership between the UCSD School Of Medicine, Scripps Mercy Hospital
Chula Vista, and the San Ysidro Health Center, Inc (SYHC). The Scripps FMRP was established with
the support of the San Diego Border Area Health Education Center (AHEC) with a goal to increase
access to quality healthcare for the medically underserved communities along the California and
Baja California border region. In January 1998 the Scripps FMRP received accreditation as a new
program from the ACGME and matched its first PGY I class in July, 1999. In November 2004 and
2009, the ACGME granted the program full accreditation for five years. The core ambulatory-care
training sites and the Family Medicine Center are located within the SYHC and its satellite clinics.
SYHC is a federally-qualified health center (FQHC). The majority of the inpatient training takes place
at Scripps Mercy Hospital Chula Vista, the institutional base for the San Diego/Border AHEC.
The family medicine residency collaborates with the Community Benefits Department at
Scripps Mercy Chula Vista and the San Diego Border AHEC to build and support a culturally
diverse, culturally competent primary health care workforce in San Diego’s medically underserved
communities. The current resident complement is seven residents per class for a total of
21 residents.
The Scripps FMRP uses a community-driven approach that emphasizes community medicine
throughout the curriculum. Through the partnership with the SYHC and their satellite clinics,
community experiences are included in rotations throughout the residency curriculum. Rotations in
Pediatrics/Adolescent Medicine, Women's Health, Behavioral Medicine, HIV care, Sports Medicine
and Geriatrics all include clinical activities in community sites and with community service agencies.
Existing community-based research activities within the department include Childhood Obesity
114
Prevention, Home-based Falls Assessment in the Elderly, and required COPC Projects for residents.
In response to the local Healthy Border 2010 objectives, the Scripps Family Medicine residency
program developed a curriculum to improve cultural and linguistic competence for our residents.
This longitudinal program incorporates the teaching of medical Spanish, cultural issues, and health
disparities in a clinically relevant context.
Chula Vista Family Clinic, a satellite clinic of SYHC, is the Family Medical Center for the Scripps
residency program. In FY10, 8,106 unduplicated patients were seen, generating 26,016 total
encounters. The patient demographics reflect the San Diego Border region; 79% of patients are
Latino, 86% of patients live at or below 200% Federal Poverty Level, and 27% of patients are
uninsured and are offered a sliding fee program.
The Scripps FMRP has recruited and matched a diverse group of residents. 50% percent of both
our current residents and our 55 graduates are members of underrepresented minority groups
(43% are Latino), reflecting the cultural and ethnic mix of the region. Our graduates further
national goals of increased primary healthcare access in their choice of practice opportunities.
70% of graduates have stayed in San Diego County, and 65% are specifically serving low-income
populations by practicing in a community health center or NHSC site, providing primary care and
a medical home to patients who might otherwise receive no care or seek care through hospital
emergency departments. (Sponsored by Scripps Mercy Hospital Chula Vista, Community Benefits).
115
SCRIPPS mERCy HoSPItAL CHULA VIStA
CommUnIty BEnEFIt SERVICES SUmmARy LISt
FY10
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Bad Debt** 0 0 $2,765,126 0
Breast Cancer Education & Support 0 838 $18,624 2,966
Charity Care 0 0 $8,292,316 0
Community Health Research – 0 169 $4,903 126
Smoking Cessation Study
Donated Room Space for Not-For-Profit 0 0 $22,304 4,414
Organizations
In Lieu of Funds 0 0 $562,561 0
Joint Replacement Class 0 12 $530 16
MCH Programs – Breast Health – 0 1,883 $28,093 6,666
Community Health Education
MCH Programs – Breast Health – 0 0 $0 3,948
Community-Based Clinical
Medicare and Medicare HMO** 0 0 $4,992,885 0
Scripps Family Medicine Residency Program 0 55,696 $2,081,019 0
Scripps Mercy Community Based Health 0 0 $0 2
Improvement – Community Health Education
Scripps Mercy Health Professionals Training 92 1,180 $37,541 473
Scripps Mercy Hospital Chula Vista Senior Programs 0 1,540 $48,960 720
Scripps Mercy Hospital Chula Vista Senior Programs – 89 236 $8,266 8
Other Professionals
Scripps Mercy Hospital Chula Vista Youth Programs 0 1,396 $32,047 2,055
Scripps Mercy Hospital Chula Vista Youth Programs – 9 236 $6,980 155
Community Based
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives.
**Community Building Activities, bad debt and Medicare shortfall do not count as community benefits under the new Schedule H 990
but are still reportable outside the community benefit table.
116
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Scripps Mercy Maternal and Child Health Programs – 0 501 $14,554 374
Community Based
Scripps Mercy Maternal and Child Health Programs – 0 342 $9,923 255
Community Health
Scripps Mercy Maternal and Child Health Programs – 0 8,478 $246,246 6,328
Health Care Support
Senior Flu Shot Clinic 0 0 $0 400
STAR Communication Enhancement Group 0 67 $4,110 283
Stroke Care Programs 0 166 $7,490 551
Unreimbursed Medi-Cal 0 0 $6,378,812 0
Unreimbursed other Means-Tested Government 0 0 $3,821,452 0
Programs
Work Force Development – Nursing and 0 562 $33,933 31
Non-Nursing
TOTAL 190 73,302 $29,418,673 29,771
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives.
**Community Building Activities, bad debt and Medicare shortfall do not count as community benefits under the new Schedule H 990
but are still reportable outside the community benefit table.
117
Scripps Green Hospital
“ Writing not only
allows people to find an
artistic outlet for their
emotions, but also provides
clinical benefits.
– Sharon Bray, EdD ”
Scripps Green Hospital
In “Writing Through Cancer” workshops, patients find the voice they need to express their emotions about their disease and reap tangible health benefits.
Writing Through Cancer
The room is quiet, except for the scratching of pens on Sharon Bray, EdD, herself a breast cancer survivor,
paper. The writers, all cancer patients, are responding to teaches, writes and facilitates When Words Heal, an
the prompt: Talk back to your cancer. eight-week workshop at Scripps Clinic and Scripps
Green Hospital, designed to help participants express the
You can see their disappointment when the facilitator complex emotions that arrive with cancer.
calls time. She asks if anyone would like to read aloud,
and one by one, they open up. “Writing allows people to find an artistic outlet for their
emotions, but it also provides clinical benefits,” says
One participant starts. “At first, you acted like a Sharon. “A number of studies have shown that people
stranger, a thief whose motives I still do not trust. who express their emotions about cancer reap tangible
Did you come to steal time, health, joy and all the health benefits, such as fewer medical appointments for
things for which we live? What made you decide to problems related to cancer and treatment.”
attach to my body when there are so many others
from which to choose?” Tom Friedman, LCSW, a social worker at Scripps Cancer
Center, helped bring Sharon to Scripps. “She has
Participants write about families, doctors, bodies, remarkable skills as a facilitator and sensitivity to issues
surgeries, organs they’ve lost. Some take their associated with living with a cancer diagnosis,” says
cancer to task, use insulting language. Others take a Friedman. He notes that the workshop has developed
compassionate, almost maternal, approach. quite a following. “As soon as each series is over, we get
calls asking when the next one will start.”
Despite differences in tone, the writers share a common
thread – catharsis. After painful treatments and the
gnawing fear of relapse, they embrace the opportunity
to write it out.
Section
9 Scripps Green Hospital
About Scripps Green Hospital
Scripps Green Hospital located on Torrey Pines Mesa above La Jolla, has 173 licensed beds, more
than 1,479 employees and provides health care services to 8.5 percent of the inpatient population
living within the hospital’s service area. Within the hospital’s service area, Scripps Green Hospital
cares for 13.2 percent of Medicare patients, 0.2 percent of Medi-Cal patients, 7.8 percent of
commercially insured patients, and 2.6 percent of patients with other payment sources, including
self-pay and charity care.
Scripps Green Hospital offers a wide range of clinical and surgical services including intensive care,
cancer/oncology, cardiothoracic and orthopedic surgeries. Among the specialty services located
on the campus are interventional cardiology, orthopedics, blood and bone marrow transplants,
solid organ transplants and clinical research. Additionally, Scripps Center for Integrative Medicine,
located on the campus, was established in 1999. Scripps Green is a teaching facility, offering
graduate medical education.
Distinguishing Programs and Services
• Bone Marrow Transplant Program
• Cancer Services
• Heart-Lung-Vascular Center
• Ida M. and Cecil H. Green Cancer Center
• Organ Transplantation and Liver Disease Center
118
SCRIPPS GREEn HoSPItAL
2011 CommUnIty BEnEFIt PLAn
FY11
The Scripps Green Hospital 2011 Community Benefit Plan provides a description of the overall
Scripps community benefit goal and the hospital’s and clinic’s objectives/strategies to support
community health improvement during Fiscal Year 2011 (October 2010 to September 2011).
Scripps’ 2011 Community Benefit Goal:
Make a measurable impact on the health status of the community through improved access to care,
health improvement programs, and professional education and health research.
Scripps Green Hospital FY11 Objectives
Community Health Services
• St. Vincent de Paul Village Medical Center and Mid-City Community Clinics – Staffed by
Internal Medicine Residents and Scripps Clinic Internal Medicine attending staff, these clinics
offer medical care to approximately 300 of our county’s most vulnerable residents each year.
Sponsored by Scripps Green Hospital, Department of Graduate Medical Education.
• Continue to conduct blood drives on behalf of the San Diego Blood Bank.
• Continue to provide physical, emotional and spiritual support to cancer patients during their
cancer treatment.
• Continue with Expressive Writing workshops series (two, 10-week sessions in 2011).
Open to all Scripps patients as well as the general community. This is a focused activity based
support group for all cancer patients. Cancer patients participate in free workshops that allow
people to find an artistic outlet for their emotions and it also provides clinical benefits.
• Participate in the 20th Anniversary Annual Cancer Survivor’s Day. Expect to have 250 people
participate.
• Continue to offer risk assessment education to high-risk women for the BRCA genes mutation
free of charge.
• Provide support services and community resources for health care workers, families, caregivers
and cancer patients.
• Provide counseling services and guidance regarding transportation, housing, homecare,
financial benefits, emotional concerns and other issues.
• Continue to work with community resources to enhance patient cancer navigator role and
patient navigator education and resources.
119
Professional Education and Research
• Fiji Alliance (School of Medicine Training) – Scripps Green and Clinic physicians will provide
specialty medicine training and supervision to undergraduate and post-graduate students
attending the Fiji School of Medicine.
• Continue to expand the Graduate Medical Education program at Scripps Green
and the Clinic. With 28 residents and 37 fellows, the Scripps Clinic–Scripps Green Hospital
Department of Graduate Medical Education serves several hundred thousand San Diegans
each year. Many of the residents in the program demonstrate a strong commitment to
community service by maintaining an evening clinic at the St. Vincent De Paul Community
Care Clinic and at the Mid-City Community Clinic in San Diego County.
Uncompensated Health Care
• Scripps Green Hospital will continue to provide health services to vulnerable patients who are
unable to pay for service.
• Maintain, communicate and effectively administer Scripps’ financial assistance policy in a
manner that meets the needs of patients.
120
SCRIPPS GREEn HoSPItAL
2011 CommUnIty BEnEFIt REPoRt
FY10
The Scripps Green Hospital Community Benefit Report is an account of the hospital’s dedication
and commitment to improving the health of the community, detailing the hospitals programs
and services that have provided benefit over and above standard health care practices in
Fiscal Year 2010 (October 2009 to September 2010).
Fostering Volunteerism
In addition to the financial community benefit contributions made during FY10, Scripps Green
Hospital employees and affiliated physicians contributed a significant portion of their personal time
volunteering to support Scripps sponsored community benefit programs and services. With close
to 1,124 hours of volunteer time, it is estimated that the dollar value associated with this volunteer
labor is $47,817.2238.
Making A Financial Commitment
During FY10, Scripps Green Hospital devoted $36,789,806 to community benefit programs and
services including uncompensated health care, community health services, professional education,
and health research. The programs offered by Scripps emphasize community-based prevention
efforts and use innovative approaches to reach residents at greatest risk for health problems.
FY10 Scripps Green Hospital Community Benefit Services Highlights
During FY10, Scripps Green Hospital contributed $36,789,806 to community benefits including,
$73,935 in bad debt, $970,429 in charity care, $1,280,691 in Medi-Cal and Other Means Tested
Government Programs, $28,922,269 in Medicare shortfall, $427,184 in community health services
and $5,102,066 in professional education and health research and $13,231 in subsidized health
services.
Refer to figure 9:1 presented on the following page for a graphical representation of the FY10
Scripps Green Hospital Community Benefit Services distribution.
38 Calculation based upon an average hourly wage for the Scripps Health system plus benefits.
121
FIGURE 9:1
FY10 Scripps Green Hospital
Community Benefit Services Distribution, $36,789,806
Subsidized
Health Services
Community $13,231 Bad Debt
Health Services 0% $73,935 Medi-Cal and Other
$427,184 0% Means-tested
1% Government Programs
Professional Education
Community $1,280,691
and Health Research
Building Activities Charity Care 3%
$5,102,066
14% 0% $970,429
3%
Medicare and
Medicare HMO
$28,922,269
79%
Community Benefit Services:
Community benefit services include those programs and services offered to the community that go
above and beyond what is provided as a normal part of patient care. Scripps categorizes community
benefit services in three categories, including uncompensated health care, community health
services, and professional education and health research. Uncompensated care includes charity
care, bad debt, Medi-Cal and Other Means-Tested Government Programs and Medicare shortfalls.
122
Scripps Green Hospital FY10 Community Benefit Services Highlights
Community health services activities include prevention and wellness programs such as screenings,
health education, support groups, and health fairs, which are supported by operational funds,
grants, in-kind donations, and philanthropy. These programs are designed to raise public
awareness, understanding of and access to identified community health needs (refer to
Section 2 – Assessing Community Needs).
During FY10 (October 2009 to September 2010), Scripps Green Hospital invested $427,184
in community health services activities. This figure reflects the cost associated with providing
community health improvement activities including salaries, materials and supplies, minus
billable revenue. This section highlights some of Green Hospital’s FY10 community benefit
services achievements.
123
Scripps Green Hospital FY10 Professional Education and Health Research
Highlights
Quality health care is highly dependent upon health education systems and medical research
programs. Without the ability to train and inspire a new generation of health care providers or to
offer continuing education to existing health care professionals, the quality of health care would
be greatly diminished. Medical research also plays an important role in improving the community’s
overall health through the development of new and innovative treatment options.
Each year, Scripps Green Hospital allocates resources to the advancement of health care services
through clinical research and medical education programs. To enhance service delivery and
treatment practices for San Diego County, Scripps Green Hospital invested $5,102,06639 in
professional training programs and clinical research during FY10 (October 2009 to September
2010). This section highlights some of Scripps Green Hospital’s professional education and health
research activities conducted in FY10.
• Internal Medicine Residency Program – With 28 residents and 37 fellows, the
Scripps Clinic – Scripps Green Hospital Department of Graduate Medical Education serve
several hundred thousand San Diegans each year. Many of the residents and attending
physicians in the program demonstrate a strong commitment to community service by
maintaining an evening clinic at the St. Vincent de Paul Village Medical Clinic and Mid-City
Community Clinics in San Diego County. With a commitment to community health, these
health care providers are working to improve the overall health of San Diegans.
• Fiji/Scripps Alliance (School of Medicine Training) – Education is critical to the Fiji
Alliance’s mission. Through a formal agreement, volunteer specialists from Scripps Health
provide academic training in the Fiji School of Medicine’s post- graduate programs for
anesthesia, surgery, internal medicine, pediatrics and obstetrics/gynecology. The program is
expanding to include nursing, information technology and biomedical engineering. Scripps is
one of only a few freestanding health systems in the U.S. to assist in such overseas academic
training programs. (Sponsored by Scripps Clinic/Green Hospital).
39 Reflects clinical research as well as professional education for non-Scripps employees, including graduate medical education, nursing
resource development and other health care professional education. Calculations based on total program expenses.
124
SCRIPPS GREEn HoSPItAL
CommUnIty BEnEFIt SERVICES SUmmARy LISt
FY10
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Bad Debt** 0 0 $73,935 0
Blood Drives for the American Red Cross 0 276 $13,015 468
Blood Drives for the San Diego Blood 0 64 $2,910 102
Cancer Center Support Groups – 0 0 $2,648 30
Scripps Green Hospital
Charity Care 0 0 $970,429 0
Donated Room Space for Not-For-Profit 0 0 $23,522 4,196
Organizations
Fiji Alliance 536 640 $77,571 2,000
In Lieu of Funds 0 0 $13,231 0
Medicare and Medicare HMO** 0 0 $28,922,269 0
Organ Transplant Support Groups 12 78 $10,177 595
Scripps Clinic – Scripps Green Hospital Department 0 136,008 $5,068,906 0
of GME
Scripps Green Hospital Medical Library 0 0 $297,341 0
St. Vincent de Paul Village Medical Center and 416 0 0 286
Mid-City Community Clinics
Unreimbursed Medi-Cal 0 0 $1,110,630 0
Unreimbursed Other Means-Tested Government 0 0 $170,061 0
Programs
USS Mercy Hospital Ship 160 0 $0 450
Work Force Development – Nursing and Non-Nursing 0 550 $33,160 26
TOTAL 1,124 137,616 $36,789,805 8,153
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives.
**Community Building Activities, bad debt and Medicare shortfall do not count as community benefits under the new Schedule H 990
but are still reportable outside the community benefit table.
125
Scripps Whittier Diabetes Institute
Diabetes Institute
Scripps Whittier
“ We believe by
promoting healthy
behaviors, including
healthy eating and
physical activity,
we can interrupt the
cycle of obesity
and Type 2 diabetes.
– Athena Philis-Tsimikas, MD ”
Project Dulce’s outcomes are exceeding national benchmarks in diabetes care, surpassing the performance of many commercial health plans and
managed care organizations.
Project Dulce and Dulce Mothers:
Caring for Families at Risk
If trends continue, half of the Latinos born today “Women who have had gestational diabetes have a
in the United States could end up with diabetes. 20- to 50-percent chance of developing diabetes in five
The incidence of diabetes among all U.S. populations, to 10 years after their pregnancy. These statistics can be
in fact, has doubled in less than 10 years. But hope is dramatically reduced if women adopt healthy lifestyles,”
on the horizon. There is strong evidence that lifestyle says Athena Philis-Tsimikas, MD, corporate vice president
changes can begin to reverse the trend. of Scripps Whittier Diabetes Institute. “We believe by
promoting healthy behaviors, including healthy eating
Project Dulce has been combating the diabetes epidemic and physical activity, we can interrupt the cycle of
in San Diego County for more than 10 years, providing obesity and Type 2 diabetes in these families.”
diabetes care and self-management education to
low-income and uninsured populations. Nurse-led teams Dulce Mothers will provide Scripps Whittier with
focus on achieving measurable improvements in the preliminary data needed to apply for additional research
health of our patients, while peer educators help them support, including research grants funded by the
overcome cultural, economic or behavioral barriers to National Institutes of Health. If successful, the project
taking care of their health. may be replicated for at-risk populations throughout the
nation and make a significant contribution to stemming
The success of the nationally recognized Project Dulce the tide of the diabetes epidemic.
also leads to new programs like Dulce Mothers.
Scripps Translational Science Institute was recently Through programs like Project Dulce and Dulce Mothers,
granted a prestigious Clinical Translational Science Scripps Whittier Diabetes Institute is working every day
Award and, as part of the award, Scripps Whittier is to improve lifestyle choices and stop diabetes – one
taking the lead on a special pilot project, Dulce Mothers: diagnosis, one family at a time.
a Community Approach to Reduce Risks of Developing
Diabetes after Gestational Diabetes.
Dulce Mothers aims to reduce the risk of diabetes
among women who have had gestational diabetes
during pregnancy. The educational component of the
project includes a series of post-partum classes on
nutrition and exercise and individual counseling by
registered dieticians.
Section
10 The Scripps Whittier Diabetes Institute
About The Scripps Whittier Diabetes Institute (SWDI)
The Scripps Whittier Diabetes Institute is dedicated to caring for and educating people with
diabetes through diabetes management and support programs. Through cutting-edge research,
the Whittier Institute strives to find a cure for this chronic disease. The mission is to improve the
quality of life for people with diabetes through innovative education programs, clinical care,
research and collaborations that pursue prevention and a cure.
Founded in 1982, The Scripps Whittier Diabetes Institute stands alone as the San Diego region’s
leading comprehensive organization for diabetes. The Whittier Institute’s mandate has always been
to achieve excellence in diabetes care, research and education and accomplishes its mission by
being a resource and partner within Scripps Health and collaborating with other institutions, their
researchers and physicians such as; University of California, San Diego; San Diego; San Diego State
University; Scripps Translational Science Institute; and San Diego Community Clinics.
126
Scripps Whittier Diabetes Institute – Distinguishing Programs and Services
• The Whittier Institute is recognized as a comprehensive and international center for excellence
in diabetes care and prevention, professional education and research.
• Operates one of the country’s largest diabetes self-management education programs
accredited by the American Diabetes Association. Nurses and dietitians with certification in
diabetes education provided hundreds of people with diabetes up-to-date and individualized
training and education.
• Credited with the first successful replication of insulin-producing human islet cells outside
the human body. Dr. Alberto Hayek’s achievement is a milestone on the pathway to making
a cure widely available. Led by five dedicated principal investigators, the Whittier-UCSD Stem
Cell Islet Research Laboratory is engaged in several projects aimed at understanding pancreas
development for translational approaches to cell-based diabetes therapies. These scientists
are significant contributors to the collaborative worldwide efforts aimed at restoring and/or
maintaining normal beta cell mass.
• Offers Project Dulce, nationally recognized as one of the most effective approaches to
addressing diabetes to low-income and diverse populations. For more than 13 years,
Project Dulce has provided diabetes care and self-management education at community
health centers, free clinics, community centers, churches, senior housing facilities and other
community locations. Nurse-led teams focus on achieving measurable improvements in the
health of their patients, while peer educators help patients overcome cultural, economic
or behavioral barriers to successfully managing their disease. Program results have been
published in medical literature and are recognized as innovative solutions to addressing the
diabetes epidemic affecting our nation. Effective methods of caring for the ever-increasing
number of ethnically and culturally diverse populations is critical to the future of our nation’s
health care system, the economy and the lives of millions of individuals.
• Gestational diabetes (GDM) occurs more frequently in women of Mexican ancestry than in
other ethnic and racial groups. Over 50 percent of women with GDM subsequently develop
Type 2 diabetes, and their children also are at high risk for the disease. Thus, as one of its
community engagement programs, STSI turned to SWDI to design a behavioral change
intervention to prevent and reduce Type 2 diabetes in low-income San Diego area women of
Mexican ancestry who have a medical history of GDM.
• Provides retinal screening to low-income persons at risk and having diabetes, which detects
eye problems early and prevents serious complications and blindness.
• Conducts community based research with a long history of building partnerships with
San Diego County and non-for-profit community clinics to prevent and treat diabetes in
San Diego’s multiethnic communities.
• Has partnered with STSI’s core capabilities in genomics science and wireless medicine to bring
expertise in community-based diabetes education and health care delivery and ultimately
create innovative new approaches to diabetes care and management.
127
• Trains health professionals locally and across the nation to provide the highest quality and
most up-to-date diabetes care. Courses are designed for health care providers seeking to
understand the new and complex clinical treatment options for Type 1, Type 2 and gestational
diabetes. The Whittier Institute’s professional education program is led by a team of experts
that include endocrinologists, nurses, dieticians, psychologists and other diabetes specialists.
• Provides technical assistance, training and direct services to Scripps hospitals with the
objective of achieving a consistent standard of care and service for glycemia management.
Direct diabetes education is provided by five certified diabetes educators at Scripps hospital
locations.
128
tHE SCRIPPS WHIttIER dIABEtES InStItUtE
2011 CommUnIty BEnEFIt PLAn
FY11
The Scripps Whittier Diabetes Institute 2011 Community Benefit Plan provides a description of the
overall Scripps community benefit goal and The Scripps Whittier Diabetes Institute’s objectives and
strategies to support community health improvement during Fiscal Year 2011 (October 2010 to
September 2011).
Scripps’ 2011 Community Benefit Goal:
Make a measurable impact on the health status of the community through improved access to care,
health improvement programs, and professional education and health research.
The Scripps Whittier Diabetes Institute FY11 Objectives
The Scripps Whittier Diabetes Program – The Scripps Whittier diabetes self-management training
and education program will integrate the diabetes education services of two large primary care and
multi-specialty groups: Scripps Clinic and Scripps Coastal Medical Group. This consolidation will
expand individual and group education as well as diabetes support groups to a total of 14 sites.
Project Dulce – Will continue to offer a comprehensive, culturally competent diabetes
management program for underserved and uninsured populations. During FY11, Project Dulce will:
• Increase the number of patients it serves.
• Continue to provide free diabetes education and support groups throughout
San Diego County.
• Work with ethnic-specific organizations to train their advocates to provide education and
referral to their communities.
• Will continue to train community health workers and health providers in Tijuana to implement
the Project Dulce model.
• Will work closely with Scripps Mercy Chula Vista hospital to link patients with diabetes that
lack a medical home to quality diabetes care, thereby reducing readmissions to the hospital
and the emergency department.
• Will continue to provide and expand the diabetes prevention education to young mothers at
increased risk of getting diabetes due to their history of gestational diabetes.
129
Community Engagement in Research
• SWDI serves as the community engagement arm of the Scripps Translational Science Institute’s
federal-funded Clinical and Translational Science Award (CTSA). As such, the Whittier Institute
is working closely with community health providers to increase the dialog between the
community and researchers regarding research topics, and is training community providers to
conduct clinical research.
• The Latino population exhibits a higher prevalence rate of Type 2 diabetes, more frequent
complications, greater disease severity, and worse outcomes than non-Latino whites;
people with Mexican and other Hispanic ancestry have not yet been adequately represented
in genomic studies. The Scripps-San Diego Diabetes Genebank will use the Project Dulce
population to recruit participants. Project Dulce is a truly collaborative, county-wide effort that
provides a blueprint for how a community can come together to use a diabetes registry to
improve and coordinate patient care, evaluate outcomes, and conduct effectiveness research.
Professional Education
• The Whittier Institute’s Professional education department will offer a number of programs to
community-based health professionals, including Safe Use of Insulin in the Hospital Setting,
Initiation and Management of Insulin and Incretin Therapy, The Fundamentals of Diabetes
Management, Demystifying the Diabetes Diet and Comprehensive Diabetes Education and
Clinical Management.
• The department also will work closely with the Diabetes Alliance to provide education to
physicians, nurses and other health professionals on the use of insulin therapy. Programs will
be conducted in 10 cities throughout the Western United States.
Community Education
• The Whittier Institute will participate in a number of community health fairs and screenings
in FY11 in order to continue to expand public awareness of diabetes, risk factors, prevention
and the importance of quality diabetes care.
• Events are planned in collaboration with the American Diabetes Association, the Juvenile
Diabetes Research Foundation, the San Diego Invitational Golf Tournament, the Take Control
of Your Diabetes (TCOYD) conference, the San Diego Auto Show and Scripps Wellness Day.
• Project Dulce will facilitate discussions to bring awareness on the importance of genomic
research as it pertains to diabetes. Such a resource will help the diabetic community at high
risk for developing the disease; unravel gene-environmental interactions in diabetes; and
design prevention strategies easily translated and implemented in the community.
The outcomes of these discussions may provide new ways to connect, detect, treat, and
maybe even prevent or cure Type 2 diabetes and other associated health problems.
130
tHE SCRIPPS WHIttIER dIABEtES InStItUtE
2011 CommUnIty BEnEFIt REPoRt
FY10
The Scripps Whittier Diabetes Institute 2011 Community Benefit Report is an account of the SWDI’s
dedication and commitment to improving the health of the community, detailing the institute’s
programs and services that have provided benefit over and above standard health care practices in
Fiscal Year 2010 (October 2009 to September 2010).
Fostering Volunteerism
In addition to the financial community benefit contributions made during FY10, Scripps Whittier
Diabetes Institute employees and affiliated physicians contributed a significant portion of their
personal time volunteering to support Scripps sponsored community benefit programs and services.
With close to 26 hours of volunteer time, it is estimated that the dollar value associated with this
volunteer labor is $1,106.0940.
The Scripps Whittier Diabetes Institute Making A Financial Commitment
During FY10, The Scripps Whittier Diabetes Institute devoted $1,025,453 to community
benefit programs and services, including uncompensated health care, community-based health
improvement activities, and professional education and clinical research. The programs offered
by SWDI emphasize community-based prevention efforts and use innovative approaches to reach
residents at greatest risk for health problems.
According to a UCLA Health Policy Research Brief, the number of people diagnosed with diabetes in
San Diego County is more than 130,000 as of August 2007. Approximately 1.7 million Californians
have been diagnosed with diabetes, and an additional 600,000 Californians are undiagnosed.
The diabetes and obesity epidemic and other chronic illnesses have a disproportionate impact
on low-income, diverse ethnic groups, yet there is little research to date demonstrating clinically
and cost effective care and treatment models for our highest risk populations. Diabetes leads
to school and work absenteeism, an elevated rate of hospitalization, frequent emergency room
visits, permanent physical disabilities, and sometimes death. Diabetes is a serious community
health problem41. Throughout the past 10 years the epidemic of diabetes has permeated every
facet of our communities. The percentage of individuals entering hospitals with diabetes is
rising; the number of children developing diabetes is growing; and larger numbers of people are
40 Calculation based upon an average hourly wage for the Scripps Health system plus benefits.
41 Community Health Improvement Partners (CHIP). Charting the Course VI 2010: A San Diego County Health Needs Assessment.
Retrieved from the World Wide Web: http://www.sdchip.org.
131
experiencing complications of diabetes, such as renal failure and heart disease, at an earlier age.
The development of unique, innovative clinical programs and community-based research is urgently
needed to combat this epidemic in our communities.
132
FIGURE 10:1
FY10 Scripps Whittier Diabetes Institute
Community Benefit Services Distribution, $1,025,453
Bad Debt
0%
Charity Care
Subsidized Health 0%
Services Medi-Cal and Other Means-tested
0% Government Programs
0%
Community
Building Activities Medicare and Medicare HMO
Professional Education
0% 0%
and Health Research Community Health
$620,575 Services
61% $404,878
39%
Community Benefit Services:
Community benefit services include those programs and services offered to the community that go
above and beyond what is provided as a normal part of patient care. Scripps categorizes community
benefit services in three categories, including uncompensated health care, community health
services and professional education and health research. Uncompensated care includes charity care,
bad debt, Medi-Cal and Other Means-Tested Government Programs and Medicare shortfalls.
133
tHE SCRIPPS WHIttIER dIABEtES InStItUtE
CommUnIty BEnEFIt SERVICES LISt
FY10
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Juvenile Diabetes Research Foundation Walk 4 1,585 $120,599 2,500
Project Dulce 0 27,056 $237,318 10,401
Scripps Whittier Diabetes Institute Professional 12 4,630 $98,815 515
Education and Training
Scripps Whittier Diabetes Research 0 7,359 $511,075 0
Scripps Whittier Dulce Mothers 0 249 $10,685 209
Scripps Whittier Mobile Medical Unit (MMU) 10 627 $45,233 697
TCOYD – SD Convention Center 0 32 $1,728 2,000
TOTAL 26 41,539 $1,025,454 16,322
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives.
**Community Building Activities, bad debt and Medicare shortfall do not count as community benefits under the new Schedule H 990
but are still reportable outside the community benefit table.
134
Scripps Medical Foundation
“ There are very few diagnoses
for which a
can be more beneficial
group lecture
Scripps Medical
Foundation
than a personal doctor visit.
Osteoarthritis is one of them.
– Howard Kaye, MD ”
People who attend the Scripps Coastal Medical Center-sponsored arthritis talks report a reduction in osteoarthritis symptoms, report less pain, fewer doctor visits
and the need for less medication.
Fighting Pain With Knowledge
Sewing, needlepoint and gardening are passions of covering such topics as Healthy Hearts, Reducing Heart
Susan Robinson, a 61-year-old retired school teacher Failure, and Weight Management. In 2010, more than
from Carlsbad. When stiffness and pain in her back 120 staff hours were committed to support the classes,
and hands robbed her of fully enjoying these pursuits, and 313 residents attended free health education classes
she stoically coped. offered at Scripps Coastal.
But when it affected her ability to keep up with her People who have attended Dr. Kaye’s lectures report
grandchildren, she knew she had to be more proactive. less pain, fewer doctor visits and the need for less
“When I’m flaring, the pain can be an eight to a medication.
10 on a 10-point pain scale,” says Susan. “I can’t
hold a pencil or work on a computer, let alone chase Education is power in dealing with this condition,
after a three-year-old. It is disheartening.” says Dr. Kaye. “There is no cure for osteoarthritis.
Because of that, education is very important so
Her doctor told her to go sit in on one of Dr. Howard people are not misled.”
Kaye’s arthritis education lectures at Scripps Coastal
Medical Center in Vista. In class, Scripps physical therapist Laura Kranz also leads
the group in gentle stretching exercises they can do
A Scripps rheumatologist and author of the while seated, demonstrating each stretch and posture
book “Arthritis: Pain Free, Side Effect Free,” shown in handouts attendees receive at the beginning
Howard Kaye, MD, has been delivering educational of the lecture.
lectures in North County for 10 years. For the past
two years, his talks have been offered for free to Dr. Kaye says osteoarthritis is rare in only one way;
the community through Scripps. “There are so very few diagnoses where a group lecture
is more beneficial than a personal doctor/patient visit.
Dr. Kaye lectures before full houses of 20 or more. Osteoarthritis is one of them.”
Most are seniors, many of whom have an osteoarthritis
diagnosis, or who haven’t yet been diagnosed but suffer “This has been so helpful, better than a book,”
the symptoms. Like Susan, some are referred by their says Susan, who took copious notes during the lecture,
doctors, while others learn of the events through local snapped her pen shut with a satisfied smile.
newspapers or Scripps’ publications and website. “And seeing so many people here was wonderful.
Scripps Coastal Medical Center provides an array of Now I don’t feel so alone with this problem.”
health education classes for the communities it serves,
Section
11 Scripps Medical Foundation
About Scripps Medical Foundation
Scripps supports a number of programs and services that meet the health care needs of patients
and community members throughout San Diego County. These include programs operated by
Scripps Clinic, Scripps Coastal Medical Center, and Scripps Cardiovascular and Thoracic
Surgery Center.
About Scripps Clinic
Founded in 1924, Scripps Clinic is a multi-specialty outpatient care facility caring for patients at
multiple locations throughout San Diego County, including Del Mar, Encinitas, Rancho Bernardo,
San Diego, Rancho San Diego, San Marcos, Santee and La Jolla. Scripps Clinic and its physicians are
world renowned for research-driven care and medical specialty expertise. Scripps Clinic contracts
with the Scripps Clinic Medical Group, Inc., which has 387 board-certified physicians in more than
50 fields of medicine and surgery. Scripps Clinic’s main facility is located on Torrey Pines Mesa,
adjacent to Scripps Green Hospital. Scripps Clinic offers the following services: Brain and Stroke
Research and Treatment Center, Musculoskeletal Center, Scripps Center for Integrative Medicine
and Scripps Clinic Center for Weight Management.
Scripps Coastal Medical Center
Scripps Coastal Medical Center is the name of the physician offices and outpatient centers created
by coming together of Scripps Mercy Medical Group and Sharp Mission Park Medical Group. With
more than 100 physicians in twelve locations throughout San Diego region, Scripps Coastal Medical
Center specializes in internal medicine, family medicine, pediatrics and operates an urgent care
center in Vista. In 2008, new locations in Carlsbad and Eastlake opened. In 2010, Scripps Health
acquired three additional locations in Del Mar, Encinitas and Vista.
Scripps Cardiovascular and Thoracic Surgery Center
Four cardiovascular surgeons of La Jolla Cardiovascular and Thoracic Surgeons joined two
cardiovascular surgeons of Scripps Clinic Medical Group to create a new cardiovascular surgery
medical group operating at the “Scripps Cardiovascular and Thoracic Surgery Center.”
Scripps Cardiovascular and Thoracic Surgery Center surgeons hold a wide range of expertise in
chest and heart surgery, performing procedures to address cardiac and pulmonary disorders.
135
SCRIPPS mEdICAL FoUndAtIon PRoGRAmS And
SERVICES 2011 CommUnIty BEnEFIt PLAn
FY11
The Scripps Medical Foundation 2011 Community Benefit Plan provides a description of the overall
Scripps community benefit goal and the system-wide objectives/strategies to support community
health improvement during Fiscal Year 2011 (October 2010 to September 2011).
Scripps’ 2011 Community Benefit Goal:
Make a measurable impact on the health status of the community through improved access to care,
health improvement programs, and professional education and research.
Scripps System-Wide Program FY11 Objectives
Community Health Services
• Scripps Coastal Medical Center will continue to provide a variety of screenings such as
awareness of body fat and blood pressure checks at various health fairs in the community.
• Scripps Coastal Medical Center will continue to provide a variety of health education classes
to seniors in the community.
• Scripps Coastal Medical Center will continue to provide health education on the following
topics to the community Osteoarthritis class,
• Scripps Coastal Medical Center will continue to provide Hep C support groups for
the community.
• Scripps Clinic will continue to provide hip and knee orthopedic surgery education to the
general public.
Uncompensated Health Care
• Scripps Medical Foundation will continue to provide health care services to vulnerable patients
who are unable to pay for services.
• Maintain, communicate and effectively administer Scripps’ financial assistance policy in a
manner that meets the needs of patients.
136
SCRIPPS mEdICAL FoUndAtIon PRoGRAmS And
SERVICES 2011 CommUnIty BEnEFIt REPoRt
FY10
This section is an account of Scripps’ dedication and commitment to improving the health of the
community, detailing the Scripps Medical Foundation programs and services that have provided
benefit over and above standard health care practices in Fiscal Year 2010 (October 2009 to
September 2010).
Fostering Volunteerism
In addition to the financial community benefit contributions made during FY10, Scripps Medical
Foundation employees and affiliated physicians contributed a significant portion of their personal
time volunteering to support Scripps sponsored community benefit programs and services.
With close to 45 hours of volunteer time, it is estimated that the dollar value associated with this
volunteer labor is $1,914.3942.
Making A Financial Commitment
During FY10, $53,771,430 was devoted by Scripps Medical Foundation programs to community
activities, including uncompensated health care, community health services, and professional
education and health research. The programs offered by Scripps emphasize community-based
prevention efforts and use innovative approaches to reach residents at greatest risk for health
problems.
During FY10, Scripps Medical Foundation contributed $53,771,430 to community benefits,
including $219,482 in charity care, $20,063 in Medi-Cal and other means-tested government
programs, $48,401,179 in Medicare shortfall, $5,114,215 in bad debt and, $4,634 in professional
education and health research and $11,856 in community health services.
Refer to Figure 11:1 presented on the following page for a graphical representation of the FY10
Scripps Medical Foundation Community Benefit Services distribution.
42 Calculation based upon an average hourly wage for the Scripps Health system plus benefits.
137
FIGURE 11:1
FY10 Scripps Medical Foundation
Community Benefit Services, $53,771,430
Subsidized
Community Health Services
Building Activities 0%
0% Charity Care
$219,482
Professional Education Bad Debt 0%
and Health Research $ 5,114,215
$4,634 10% Medi-Cal and Other
Community 0% Means-tested
Health Services Government Programs
$11,856 $20,063
0% 0%
Medicare and
Medicare HMO
$48,401,179
90%
Community Benefit Services:
Community benefit services include those programs and services offered to the community that go
above and beyond what is provided as a normal part of patient care. Scripps categorizes community
benefit services in three categories, including uncompensated health care, community health
services and professional education and health research. Uncompensated care includes charity care,
bad debt, Medi-Cal and Other Means-Tested Government Programs and Medicare shortfalls.
138
Scripps Medical Foundation FY10 Community Health Services Highlights
Community health services include prevention and wellness programs such as screenings, health
education, support groups and health fairs, which are supported by operational funds, grants,
in-kind donations and philanthropy. These programs are designed to raise public awareness,
understanding of and access to identified community health needs (refer to Section 2 – Assessing
Community Needs).
139
SCRIPPS mEdICAL FoUndAtIon CommUnIty
BEnEFIt SERVICES LISt
FY10
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Bad Debt** 0 0 $5,114,215 0
Blood Drives for the American Red Cross 0 98 $4,632 249
Charity Care 0 0 $219,482 0
Community Health Education Classes – 45 123 $7,224 313
Scripps Coastal Medical Center
Medicare and Medicare HMO** 0 0 $48,401,179 0
Unreimbursed Medi – Cal 0 0 $20,063 0
Work Force Development – Nursing and 0 77 $4,634 3
Non–Nursing
TOTAL 45 298 $53,771,430 565
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives.
**Community building activities, bad debt and Medicare shortfall do not count as community benefits under the new Schedule H 990
but are still reportable outside the community benefit table.
140
Scripps System-Wide
“greatest joysonetoofsee
After the surgery, I was able
my
to experience
–
my beautiful granddaughter
for the very first time.
– Ricardo Hernandez”
Scripps System Wide
Ricardo Hernandez was in grave danger of losing his vision when he visited a community clinic supported by Scripps Whittier Diabetes Institute;
Paul Tornambe, MD, made sure he didn’t.
An Eye-Opening Experience
Ricardo Hernandez has lived with diabetes for more than “Each time I had a treatment, I felt a little better,” says
seven years. During that time, the 43-year-old National Ricardo. “I believed the doctors were going to save my
City resident has seen deterioration in his eyesight eyesight – and my livelihood. If I went blind, there would
as a result of the disease. Deeply concerned that he be no way I could support my wife, my children and my
would permanently lose his vision, he learned about grandchildren.”
a free retinal screening program offered at a nearby
community clinic, which was supported by Scripps Because of the severity of Ricardo’s case, he also needed
Whittier Diabetes Institute. retinal vitrectomy surgery to stop the bleeding and
prevent a detached retina in his right eye. Through the
When ophthalmologist Paul Tornambe, MD, and collaboration of Scripps leaders, physicians and staff,
George Hayes, manager of the Scripps mobile medical Dr. Tornambe successfully performed the surgery at
unit, met Ricardo, they recognized the urgency of his Scripps Memorial Hospital La Jolla. The retinal screening
situation. Ricardo had severe retinopathy and clinically program is made possible by contributions from Blue
significant macular edema, which if left untreated, Shield of California, Fonseca Foundations and Scripps
would lead to blindness. Community Benefit Program.
“Ricardo had a massive hemorrhage in his right eye “Words cannot express my gratitude,” says Ricardo.
and his left eye was also bleeding,” says Dr. Tornambe. “After the surgery, I was able to experience one of my
“We immediately began care; first, with injections of greatest joys – to see my beautiful granddaughter for
a medication to shrink the blood vessels in the eyes, the very first time.”
and then with laser treatments in an effort to stop the
bleeding.”
Dr. Tornambe, a great champion for the prevention
and early treatment of diabetic retinopathy, has been
volunteering at the weekly clinic for five years. Retinal
photographs of patients are taken aboard the Scripps
mobile medical unit and then Dr. Tornambe is able to
interpret the screenings and recommend any follow-up
care. More than 100 patients, many suffering from vision
complications as a result of their diabetes, receive retinal
screenings each month.
Section
12 Scripps System-Wide Programs
About Scripps System-Wide Programs and Services
Scripps supports a number of programs and services that meet the health care needs of patients
and community members throughout San Diego County. These include programs operated by
Scripps Home Health Services, Scripps Cancer Services, the Scripps Clinical Research Center and
Scripps System Community Benefit Services.
Scripps Home Health Services
Scripps Home Health Care Services provides a range of health care services in people’s homes.
During FY10 this multidisciplinary team of caregivers provided professional home care services
as well as education on disease prevention and management, medications, diet and exercise to
approximately 5,000 patients throughout San Diego County. More than 160 nurses, therapists and
support staff work closely with the patients’ physicians and family to offer a variety of services,
including nursing care, physical, occupational and speech therapy 365 days per year.
Home Health includes the following distinguished programs and services: Cardiovascular Care,
Wound Management, Diabetic Care, Physical Therapy, Occupational Therapy, Speech Therapy,
Dietary Services and Medical Social Services.
Scripps Mobile Medical Unit
Scripps operates a 40-foot Mobile Medical Unit which provides diabetes prevention, screening
and education services, as well as community disaster relief communications systems. This unit
is equipped with two exam rooms, lab, and retinal camera. State-of-the-art telecommunications
equipment enables unit staff to send test results to a physician’s office for review in minutes.
The unit is also equipped with triage and specialized communications systems so it can be used by
the community during disaster situations.
Scripps Cancer Center
Scripps Cancer Center (SCC) is a system-wide approach to the provision of cancer services across all
Scripps hospital campuses and ambulatory care sites. Through SCC, clinicians, scientists and health
care professionals with expertise in research, treatment, education and prevention have come
together to create a powerful cancer resource in San Diego County. Today, Scripps adds
100 new clinical trials each year at its five hospitals, the Scripps Clinic medical group and
Scripps Cancer Center. In addition, there are major contributions from investigator-initiated research
projects, some of which have produced new, state-of-the-art medical devices and technologies that
are used worldwide.
141
Scripps Cancer Center includes the following distinguished programs and services: Screening
services, diagnostic services, ultrasound and ultrasound-guided breast biopsy, stereotactic-guided
core breast biopsy, breast needle localization biopsy, computed tomography (PET).
Scripps Clinical Research Center (SCRC)
Research and clinical discovery have been part of Scripps Health’s mission since its founding in
1924. Today, Scripps adds approximately 100 new clinical trials each year. Clinical Research Services
consolidates and expands access to clinical research for physicians and patients across the Scripps
system and in all the communities Scripps serves. The research mission is to provide comprehensive,
expert support to Scripps physicians and staff so that they may provide patients with access to
the best research treatments. In addition, Scripps aligns its research objectives with the ongoing
continuing and graduate medical education programs that provide cutting-edge programs to
Scripps health care professionals.
In 2007, Scripps made substantial investments to establish the Scripps Genomic Medicine program
and Scripps Translational Science Institute (STSI). A year later in partnership with The Scripps
Research Institute – STSI was selected to receive a National Institutes of Health Clinical Translational
Science Award. The five-year, $20 million grant supports research infrastructure and training.
In 2008, the Scripps Clinical Research Center was created to support clinical research throughout
the Scripps system. Scripps Clinical Research Center has brought together more than 25 medical
specialties under one roof. The center is designed to accelerate the delivery of new technologies to
patients by bringing together the majority of components needed to initiate and conduct clinical
investigation in one seamless, streamlined regulatory and administrative process.
Scripps is building on a strong foundation for clinical and translational research encompassing the
entire range of clinical investigation – from small pilot studies to large multicenter trials. All Scripps
hospitals are engaged in research involving inpatient care. Ambulatory-based research is increasing
in all Scripps’ clinical settings. Scripps currently supports more than 200 principal investigators and
about 350 active clinical research protocols crossing broad interdisciplinary disease categories.
142
Type of Scripps Clinical Research Services Trials
• Arthritis • Hepatitis C
• Cancer (various tumor sites) • High Cholesterol
• Cardiology • Joint Replacement
• Chronic Lung Disease • Liver Disease
• Cosmetic Procedures • Migraine Headaches
• Dermatology • Neuro-Imaging
• Epilepsy • Obesity/Weight Loss
• Eye Infections • Organ Transplant
• Eye – Macular Degeneration • Osteoporosis
• Eye – Cataracts • Orthopedics
• Genomic Directed • Parkinson’s Disease
• Growth Hormone Deficiency • Stroke
Scripps Translational Science Institute (STSI)
The Scripps Translational Science Institute is dedicated to accelerating the “translation” of basic
science to clinical trials and clinical treatment. The institute identifies promising opportunities
among existing research efforts at both Scripps Health and The Scripps Research Institute to provide
seed funding to physician researchers across the Scripps Health system. This funding supports the
researcher in preparation for the pursuit of National Institutes of Health grant funding or other
associated grants. As part of Scripps Translational Science Institute, the Scripps Genomic Medicine
Program supports basic research and clinical programs designed to understand an individual’s
genetic susceptibility to disease and to forward those findings into drug discovery and clinical trials.
Scripps Genomic Medicine, an initiative of Scripps Health in collaboration with The Scripps Research
Institute (TSRI), will support basic research and clinical programs focused on defining the genes
that underlie susceptibility to disease, and take these findings into drug discovery programs and
ultimately into clinical trials.
The program’s work will involve genotyping tens of thousands of individuals of diverse ancestry in
an attempt to identify and define genes responsible for major disease and the underpinnings of
health. The identification of these genes may lead to drug discovery and gene-specific clinical trials.
Current research includes studying women’s DNA variants to determine the likelihood of developing
breast cancer and using that genetic risk data to guide mammogram frequency. Another study,
called the Wellderly Study, looks at the healthy elderly who are 80 years of age or older with no
history of chronic diseases to help unlock the genetic secrets behind the lifelong health. The rich
diversity of the San Diego population – the primary patient base of the Scripps program – provides
unparalleled opportunities for this research.
143
Scripps System Community Benefit Services
Scripps System Community Benefit Services provides oversight, support, guidance and coordination
of Scripps community health and outreach program initiatives, helping to ensure that they are
in accordance with the Scripps mission, values and strategic goals/objectives. This program also
supports the Strategic Planning Committee, a committee of the Scripps Board of Trustees, in
assessing and planning to meet community need. Additionally, this program is responsible for
developing the triennial health needs assessment in collaboration with the Community Health
Improvement Partners (CHIP) and through the Community Benefit Fund provides funding to
support community programs that address San Diego County’s high-priority health needs.
144
SCRIPPS SyStEm–WIdE PRoGRAmS And
SERVICES 2011 CommUnIty BEnEFIt PLAn
FY11
The Scripps System-Wide 2011 Community Benefit Plan provides a description of the overall Scripps
community benefit goal and the system-wide objectives/strategies to support community health
improvement during Fiscal Year 2011 (October 2010 to September 2011).
Scripps’ 2011 Community Benefit Goal:
Make a measurable impact on the health status of the community through improved access to care,
health improvement programs, and professional education and research.
Scripps System-Wide Program FY11 Objectives
Community Health Services
Community Benefit Fund – Provide a minimum of $100,000 in grant funding to support
community programs that address San Diego County’s high-priority health needs. (Funded by
Scripps Health System, Community Benefit Services).
Mobile Medical Unit – The Mobile Medical Unit (MMU) will continue to provide diabetes
prevention, screening for diabetes and diabetic retinopathy, and education services directly to
the communities served by Scripps. The MMU participates in community health fairs, and will be
available to respond to disasters as part of Scripps’ preparedness efforts.
School Partnerships
• Partner with the San Dieguito Academy to offer the following activities; job shadowing,
mentoring, guest speakers’ bureau, internships, volunteer opportunities, health facility tours,
strategies for student success in health occupations and reviewing student portfolios and/or
senior exhibitions. (Initiative led by Scripps Health System, Community Benefit Services)
• Collaborate with Point Loma Nazarene School of Business to introduce health care business
courses for MBA program.
• Serve as beta site for Mesa Community College’s Radiology Certification Program.
• Partner with San Diego State University to continue the expansion of Masters and PhD
program alliances.
• Expand Grand Canyon University on-line Bachelors and Masters-Nursing, Masters-Healthcare
Clinical Leader and Masters-Clinical Education.
• Continue expansion of community and nationally recognized schools/universities that provide
education in support of Scripps strategic goals.
145
Disaster Preparedness: Community Outreach and Education
Having the ability to provide emergency services to those injured in a local disaster while continuing
to care for hospitalized patients is a critical community need. To this end, Scripps together with
other first-responder agencies (public and private), will engage in a variety of training, outreach and
planning initiatives during FY11, including:
• Participate in San Diego County and State of California advisory groups to plan, implement
and evaluate key disaster preparedness response plans.
• Collaborate with State of California Emergency Medical Services Authority on state projects,
and state/federal grant opportunities.
• Collaborate with Emergency Medical Services, County of San Diego to provide disaster
preparedness training curriculum to San Diego Healthcare Organizations.
• Provide a Community Partner Disaster Planning conference and one 16 hour decontamination
response team training for health care partners.
• Participate in community education locally and nationally as an organizational leader in
disaster preparedness and planning.
• Available to provide Scripps Medical Response teams and Scripps Hospital Administrative
Support teams to any domestic or international disaster event. (Initiative led by the disaster
preparedness program under the direction of the Scripps Chief Medical Officer).
American Heart Walk – The ScrippsAssists employee volunteer program will again coordinate
walker participation and fund raising efforts in support of the American Heart Association’s Annual
Heart Walk. Scripps Health will also allocate operational funds to support the American Heart
Association’s efforts to fight heart disease and stroke. (Initiative led by Scripps Health System,
Community Benefit Services).
Professional Education and Health Research
Scripps High School Exploration Program and Regional Allied Health and Science Initiative
(RASHI) – Continue to provide education internships for 35 students, offering eight week-long
paid internship where students rotate through clinical and non-clinical departments to learn about
health care.
For FY10, the Scripps High School Exploration program plans to expand to all Scripps hospitals.
(Funded by Scripps Health System Operations).
• Continue program expansion system-wide and host 35 students with rotations throughout
2010 school year.
• Launch Scripps Health system-wide New Grad Residency and Training Program.
• Launch Scripps Health system-wide ICU Training Program.
• Continue expansion of local college-based internship programs to include MBA,
System Engineering and Allied Services.
146
Uncompensated Health Care
• Scripps Home Health Care will continue to provide health care services to vulnerable patients
who are unable to pay for services.
147
SCRIPPS SyStEm–WIdE PRoGRAmS And
SERVICES 2011 CommUnIty BEnEFIt REPoRt
FY10
This section is an account of Scripps’ dedication and commitment to improving the health of the
community, detailing the system-wide programs and services that have provided benefit over and
above standard health care practices in Fiscal Year 2010 (October 2009 to September 2010).
Fostering Volunteerism
In addition to the financial community benefit contributions made during FY10, Scripps System
employees contributed a significant portion of their personal time volunteering to support
Scripps-sponsored community benefit programs and services. With 14,297 hours of volunteer
time, it is estimated that the dollar value associated with this volunteer labor is $608,223.1242.
Making A Financial Commitment
During FY10, $20,754,577 was devoted by Scripps System-Wide programs to community
activities, including uncompensated health care, community health services, and professional
education, and health research. The programs offered by Scripps emphasize community-based
prevention efforts and use innovative approaches to reach residents at greatest risk for health
problems.
FY10 Scripps System-Wide Community Benefit Services Highlights
During FY10, Scripps System-Wide contributed $20,754,577 to community benefits, including
$363,417 in Medi-Cal and other means-tested government programs, $114,988 in Medicare and
Medicare HMO, $1,410,198 in community health services, $18,262,793 in professional education
and health research, and $603,180 in Community building activities.
Refer to Figure 12:1 is a graphical representation of the FY10 Scripps System-Wide Community
Benefit Services distribution.
42 Calculation based upon an average hourly wage for the Scripps Health system plus benefits.
148
FIGURE 12:1
FY10 Scripps System-Wide
Community Benefit Services Distribution, $20,754,577
Charity Care
0%
Medi-Cal and Other
Bad Debt Means-tested
0% Government Programs
Subsidized $363,417 Medicare and
Community Health Services 1.8% Medicare HMO
Building Activities 0%
$114,988
$603,180 0.6% Community Health Services
2.9% $1,410,198
6.8%
Professional
Education and
Health Research
$ 18,262,793
88%
Community Benefit Services:
Community benefit services include those programs and services offered to the community that go
above and beyond what is provided as a normal part of patient care. Scripps categorizes community
benefit services in three categories, including uncompensated health care, community health
services, and professional education and health research. Uncompensated care includes charity
care, bad debt, Medi-Cal and Other Means-Tested Government Programs and Medicare shortfalls.
149
Scripps System-Wide FY10 Community Health Services Highlights
Community health services include prevention and wellness programs such as screenings, health
education, support groups and health fairs, which are supported by operational funds, grants,
in-kind donations and philanthropy. These programs are designed to raise public awareness,
understanding of and access to identified community health needs (refer to Section 2 – Assessing
Community Needs).
During FY10 (October 2009 to September 2010), $1,410,198 was invested by Scripps
System-Wide programs and services in community-based health improvement activities.
This figure reflects the cost associated with providing community health improvement activities,
including salaries, materials and supplies, minus billable revenue. This section highlights some of the
Scripps system-wide FY10 community health services.
Scripps Health Community Benefit (CB) Fund – In 2010, Scripps awarded a total of $200,000
in community grants to programs based throughout San Diego. Scripps awarded six grants ranging
from $10,000 to $120,000 each. The projects that received funding address some of San Diego
County’s high-priority health needs with the goal of improving access to vital health care services
for a variety of at-risk populations, including the homeless, economically disadvantaged, mentally
ill and others. Since the Community Benefit Fund began, Scripps has awarded $1.7 million dollars.
Programs funded during FY10 include:
• CB Fund – Catholic Charities – Funding awarded to provide short-term emergency shelter
to medically fragile homeless patients being discharged from Scripps Mercy Hospital
San Diego. Case management and shelter is provided for previously homeless patients
discharged from Scripps Mercy Hospital who no longer require hospital care but do need
a short-term supportive recuperative environment. Patients demonstrating a readiness for
change are assisted with one week in a hotel along with food and bus fare to pursue case
plan. The focus of the case management is to stabilize the client by helping them connect
to more permanent sources of income, housing and ongoing supports for efforts toward
self-reliance. The goal of this partnership is to reduce the incidence of ER recidivism in this
population and improve the quality of life for the patient.
• CB Fund – 2-1-1 New Access System – Funding was awarded for ongoing operations of its
telephone dialing code, which provides the public with information about community, health
and disaster services. 2-1-1 San Diego is the dialing code for information about community,
health and disaster services. It connects people with resources over the phone, online and in
print. Locally, 2-1-1 San Diego was launched in June 2005 as a multilingual and confidential
service committed to providing access 24/7.
150
• CB Fund – Partnership for Smoke-Free Families – The Partnership for Smoke-Free
Families Program (PSF) is a comprehensive tobacco control program to reduce tobacco smoke
exposure among pregnant women and small children by systematically screening pregnant
women and new parents for tobacco use in their obstetrician’s and pediatrician’s office and
linking them with tailored interventions. PSF has become a standard of care in San Diego
County and a nationally recognized model. PSF provides a valuable resource for physicians
and smoking cessation services specifically for pregnant women and new parents that was
previously non-existent in San Diego.
• CB Fund – American Heart Association – Funding awarded for the 2010 Heart Walk
n
sponsorship. Heart disease and stroke are the number one and umber three causes of death
in the nation for men and women. Heart disease is the nation’s leading cause of death,
claiming more than 950,000 American lives each year. Scripps partners with the American
Heart Association on their annual Heart Walk, to raise funds for research, professional and
public education and advocacy.
C
• B Fund – Consumer Center for Health Education and Advocacy (CCHEA)
Funding provides low income uninsured Mercy Clinic patients and Behavioral Health patients
who need assistance in obtaining healthcare benefits, SSI and related services, while
simultaneously reducing uncompensated care expenses for Mercy. This project provides
advocacy services for the time-intensive government benefit cases. (Sponsored by Scripps
Mercy Hospital Administration).
Cancer/Oncology
Cancer is the second leading cause of death in the U.S. exceeded only by heart disease and
accounts for almost one quarter of all deaths in San Diego County. According to National Cancer
Institute (NCI) estimates, in 2009 there will be 1,479,350 new cases of cancer diagnosed and an
estimated 562,540 deaths related to cancer. Currently lung, breast, colorectal and prostate cancers
accounted for 53% of all new cases of cancer and 50% of all cancer deaths43.
In response to this serious health concern, Scripps has developed a series of prevention and
wellness programs designed to educate people on the importance of early detection and treatment
for some of the most common forms of cancer. During FY10, Scripps engaged in the following
cancer programs and activities.
Breast and Cervical Cancer
Cancer Control – Scripps Breast Cancer Diagnosis Project (Scripps Project) Provides free diagnostic
imaging services to low-income, medically uninsured or underinsured women age 39 and younger,
43 Community Health Improvement Partners (CHIP). Charting the Course VI 2010: A San Diego County Health Needs Assessment.
Retrieved from the World Wide Web: http://www.sdchip.org.
151
and men of any age, who reside in San Diego and present with a breast mass or abnormality.
This project is funded by Susan G. Komen for the Cure, San Diego and the Scripps Cancer Center.
In FY10, 126 qualified community members participated in the program, 76 received diagnostic
mammograms, 77 received breast ultrasounds and 33 received biopsies. Four cancer cases were
detected. (Initiative led by Scripps Cancer Center).
Cancer Detection Programs: Every Woman Counts
This is a state of California grant program that provides free breast and cervical cancer tailored
health education to low-income, uninsured and underinsured women who reside in San Diego
and Imperial Counties. Unfortunately this State grant ended in June 2010. Scripps Health provided
clinical administrative oversight over 75 community-based clinics that are contracted with the state
to provide free breast cancer screenings for women age 40 and older and cervical cancer screenings
for women age 25 and older. During FY10, the following outcomes were achieved: Education –
Breast and cervical cancer early detection and prevention education was provided to 536 qualifying
women.
Cardiovascular Disease
Coronary Heart Disease and Stroke are the number one and number three causes of death in the
nation for both men and women. Heart disease is our nation’s leading cause of death, claiming
more than 950,000 American lives every year. Stroke is America’s third killer and is a leading cause
of serious, long-term disability44. During FY10, Scripps engaged in the following heart
health/cardiovascular disease prevention and treatment activities.
American Heart Walk
Scripps allocated $10,000 in operational funds and $30,000 in in-kind donations to support
the American Heart Association’s efforts to fight heart disease and stroke. In addition, the
ScrippsAssists employee volunteer program coordinated walker participation and fund raising
efforts. The San Diego Heart Walk exceeded its goal by raising more than $1 million. In 2010, more
than 2,400 Scripps Heart Walk participants – employees, families and friends – walked to help raise
more than $149,000 Additionally, Scripps reached out to the community at the event by providing
blood pressure screenings, health education materials and more.
Substance Abuse and Tobacco Use
Partnership for Smoke-Free Families – Second-hand smoke is clearly a community health risk
attributing to low birth weight in newborns, Sudden Infant Death Syndrome (SIDS), respiratory
infections, asthma and middle-ear disease in infants and children. The Partnership for Smoke
Free Families (PSF) is a collaborative effort supported by Scripps, Sharp Healthcare, and Children’s
Hospital and focuses on improving the health and well being of children by reducing their exposure
44 Community Health Improvement Partners (CHIP). Charting the Course VI 2010: A San Diego County Health Needs Assessment.
Retrieved from the World Wide Web: http://www.sdchip.org.
152
to second-hand smoke. The Partnership for Smoke-Free Families Program has become a standard
of care in San Diego County and a nationally recognized model for systematically screening and
linking pregnant women and their families with small children exposed to tobacco smoke with
interventions. As of November 30, 2010 nearly 300,000 pregnant women and parents of small
children have been screened for tobacco use/exposure and more than 55,000 proactively linked
with targeted interventions. (Funded by Scripps Health System, Community Benefit Services).
Emergency/Disaster Preparedness
Disaster Preparedness: Community Outreach and Education – Having the ability to provide
emergency services to those injured in a local disaster while continuing to care for hospitalized
patients is a critical community need. Scripps participated in San Diego County and state of
California advisory groups to plan, implement and evaluate key disaster preparedness response
plans and exercises. Scripps is an advisor to SD County for federal and state grant development
and planning. Scripps deployed the Scripps Medical Response Team to Port au Prince Haiti to
provide disaster relief medical aide to those injured in the 2010 earthquake. Three teams of medical
providers supported by logistic team leaders provided medical care at St. Francois de Sale Hospital
for thousands of earthquake victims.
Disaster Preparedness: Mobile Field Hospital
Hospital Administrative Support Unit and Scripps Medical Response Team – Having the ability to
provide emergency services to those injured in a state of California disaster while continuing to
care for hospitalized patients is a critical community need. Scripps Maintain active readiness for the
Scripps Hospital Administrative Unit and the Scripps Medical Response Team both are lead teams
for the State of CA Mobile Field Hospital deployment. Both teams were on standby for deployment
to Haiti after the earthquake, but the hospital was never deployed. Scripps continues to participate
with the State of CA in an advisory capacity developing the scope of the Mobile Field Hospital with
plans to participate in the 2011 State Wide Field exercise.
Disaster Preparedness: H1N1 Vaccine Clinics for the Community – Due to the critical need to
vaccinate the community through January of 2010 for H1N1 pandemic flu, Scripps collaborated
with the San Diego Public Health Department and volunteered to vaccinate all Scripps employee
families, and all affiliated physicians and volunteers.
Disaster Preparedness: San Diego County and National Community Support and outreach
Education – The goal is to participate in community education locally and nationally as an
organizational leader in disaster preparedness and planning. In FY10, Scripps participated in the
San Diego Business Consortium and led multiple lectures to government and community audiences:
• Oct. 27, 2010 – Catholic Health Care West Annual Safety, Security and Disaster Management
Conference – Security and Safety – Disaster Response and Mission to Haiti, Scripps Experience
153
• July 28, 2010 – 2010 South Carolina Society for Healthcare Emergency Management –
Keynote Speaker – Health Care Evacuation and Medical Response to Haiti
• July 22 and July 23, 2010 – U.C. Irvine and Stanford University – Association of Healthcare
Security, California Region 12 Annual Symposium – Professional Liability: Do you Know What
You Don’t Know? Keynote speaker, Safety First, the Motto for Disaster Response Plans
• April 15, 2010 – Dept. of Public HS Licensing and Certification – RAP Session – Long Term
Care Conference – Hospital partnership – Community collaboration
• Nov. 15, 2009 – Canadian College of Health Care Executives – Panelist – Pandemic Flu
Planning, Business Continuity and Community Focus Group
• Oct. 19, 2009 – Dept. Homeland Security National Infrastructure Protection Office – Public
Health Joint Advisory Work Group- Business Continuity for Health Care – panel participant.
• Oct. 1, 2009 – Burnham Institute of Medical Research, panel participant: Pandemic Flu,
Know the Enemy Community Forum Scripps Conference and Training
• Scripps First Annual Disaster Preparedness Conference, June 25, 2010. Hosted over
50 community partners.
• Community Decontamination Response Team training, June 30 and July 1, 2010.
Hosted 16 hour training for Scripps Employees and community hospital partners.
(Initiatives led by the Disaster Preparedness program under the direction of the Chief Medical
Officer).
154
Scripps System-Wide FY10 Professional Education and Health
Research Highlights
Quality health care is highly dependent upon health education systems and medical research
programs. Without the ability to train and inspire a new generation of health care providers or to
offer continuing education to existing health care professionals, the quality of health care would be
greatly diminished.
Each year resources are allocated by Scripps System-Wide programs and services to the
advancement of health care services through professional health education programs and research.
To enhance service delivery and treatment practices for San Diego County, $18,262,79345 was
invested by Scripps System-Wide programs and services in professional training programs and
research during FY10 (October 2009 to September 2010). This section highlights some of the
Scripps System-Wide professional education and research activities conducted in FY10.
Scripps High School Exploration Program and Regional Allied Health and Science Initiative
(RASHI) – Launched by Scripps Health, the program is designed to reach out to young people
and pique their interest in health care occupations which are in dire need of recruits. From the
emergency room to marketing, the students rotate through numerous departments, exploring
career options and learning life lessons about health and healing along the way. During FY10,
Scripps Health had a partnership with RASHI to provide continuing education internships for their
students. The program offered eight week-long paid internships where 35 students rotated through
clinical and non-clinical departments to learn about health care. Received $25,000 grant
to continue to expand the scope of program across the San Diego community. (Funded by
Scripps Health System Operations).
45 Reflects clinical research as well as professional education for non-Scripps employees, nursing resource development and other health
care professional education. Calculations based on total program expenses. Clinical research includes the subsidy which is the operating
Income/(Loss) of Scripps’ research entities: Scripps Clinical Research Services, Scripps Whittier Institute, Scripps Genomic Medicine and
Scripps Translational Science Institute.
155
SCRIPPS SyStEm–WIdE CommUnIty
BEnEFIt SERVICES LISt
FY10
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
2-1-1 San Diego Annual Fundraising 0 0 $5,000 0
Alpha Project 0 0 $1,000 0
American Heart Association Heart Walk 5,039 3,670 $178,635 2,500
American Heart Association Heart Walk 0 0 $29,010 0
- In-Kind Donation
American Heart Association Heart Walk 0 0 $10,000 0
- Sponsorship
Blood Drives for the American Red Cross 0 341 $16,755 795
Cancer Control – Breast Cancer Diagnosis Project 0 1,689 $70,106 126
Cancer Detection Programs: Every Women Counts 0 6,361 $411,896 536
Cancer Registry 0 17,266 $916,998 0
CB Fund – 2-1-1 San Diego 0 0 $15,000 0
CB Fund – Catholic Charities 0 0 $40,000 150
CB Fund – Partnership for Smoke Free Families 0 0 $15,000 0
CHIP – Community Health Improvement Partners** 0 510 $68,495 0
Clinical Research Services 0 205,099 $9,711,769 0
Community Health Improvement Partners – 0 0 $5,245 0
CHIP Flight 15: Our Journey to Better Health
Fundraising Event**
Container Sponsorship Program: Haiti 0 0 $16,500 0
Disaster Preparedness – Community Outreach 0 130 $14,023 219
and Education**
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives.
**Community Building Activities, Bad Debt and Medicare Shortfall do not count as community benefits under the new Schedule H 990
but are still reportable outside the community benefit table.
156
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Disaster Preparedness – San Diego County and 0 24 $2,048 1,005
National Community Support and Outreach
Education
Economic Development – Community Building** 0 466 $95,892 0
Emergency Response Course & CPR/AED for the 0 29 $9,290 105
Professional Rescuer & Health Provider
Epilepsy Foundation of San Diego 0 0 $500 1,800
Health and Safety Fair – Scripps Home Health 0 55 $3,375 550
Services
Health Care Reform and Legislative Advocacy** 1 1,800 $402,424 0
Heart Health – Scripps Home Health 0 12 $787 116
Services
LEAD San Diego Visionary Awards** 0 0 $5,000 800
Learning for Life San Diego – Imperial Council Boy 0 0 $5,000 0
Scouts of America**
Medicare and Medicare HMO** 0 0 $114,988 0
Monarch School Holiday Drive 0 6 $3,415 120
Prescription Drug Take Back Day 0 120 $16,572 0
Prevention of Cardiovascular Disease – Scripps Home 0 14 $753 106
Health Services
Recertification CPR/AED for the Professional Rescuer 0 2 $504 1
and Health Care Provider
San Diego Nursing Service/Education Consortium** 215 0 $1,300 600
Scripps Genomics Medicine and Translational 0 71,673 $7,485,114 0
Research
Scripps Haiti Mission 720 2,552 $283,364 1,700
Scripps Health System Community Benefit Planning 0 2,797 $189,229 0
and Outreach
Scripps High School Exploration Program 7,620 6,660 $148,913 35
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives.
**Community Building Activities, Bad Debt and Medicare Shortfall do not count as community benefits under the new Schedule H 990
but are still reportable outside the community benefit table.
157
Volunteer Staff Financial Persons
Program Title Hours Hours Support* Served
Scripps Recuperative Care Program 0 412 $79,822 26
Super Food Drive and San Diego Food Bank Event 2 106 $5,983 0
Susan G. Komen Race for the Cure 0 0 $5,000 0
U.C. High School Exploration Program 700 0 $0 13
University of Southern California School of Policy, 0 0 $2,500 0
Planning and Development**
Unreimbursed Medi-Cal 0 0 $363,417 0
Vitamins and Nutrition as you Age – Scripps Home 0 12 $656 106
Health Services
YWCA Tribute to Women and Industry** 0 0 $3,300 0
TOTAL 14,297 321,806 $20,754,578 11,409
*”FINANCIAL SUPPORT” reflects the cost (labor, supplies, overhead, etc.) associated with the program/service less direct revenue.
This figure does not include a calculation for physician and staff volunteer labor hours. In some instances an entire community benefit
program cost center has been divided between several initiatives.
**Community Building Activities, Bad Debt and Medicare Shortfall do not count as community benefits under the new Schedule H 990
but are still reportable outside the community benefit table.
158
Appendices
Appendices
Section
13 Appendices
Appendix A: Definition of Terms
Bad Debt – Unpaid costs for care that is provided to persons who do not meet the criteria for
charity care, are not covered by a third-party payer or have a co-payment obligation that is not met.
Charity Care – The portion of patient care services provided by Scripps for which a third-party
payer is not responsible and a patient has the inability to pay. Charity care does not include bad
debt, contractual adjustments, or under-reimbursed costs (payment shortfalls). Charity care may
include unpaid coinsurance, deductibles, and non-covered services if the patient meets the
Scripps charity care eligibility criteria.
In-Lieu of Funds – Funds used for unfunded or underfunded patients and their post-discharge
needs. Funds are used for board and care, skilled nursing facilities, long term acute care, and home
health. In addition funds are also used for medications, equipment, and transportation services.
Community Benefit Services – Programs/services offered to the community that go above
and beyond what is provided as a normal part of patient care. Scripps Health categorizes
Community Benefit services in three categories:
• Uncompensated Health Care – Includes charity, under-reimbursed care, and bad debt.
Shortfalls are derived using the payor based cost allocation methodology. Bad debt and
charity care are estimated by extracting the gross write offs of bad debt and charity care
charges and applying the hospital RCC to estimate net uncompensated cost.
• Community Health Services – Services and activities carried out to improve community
health that usually do not generate a patient bill and are subsidized by the hospital.
• Community-Based Health Improvement Activities – These activities are carried out
to improve community health and must be supported by a community need.
They extend beyond patient care activities. They include services directed to individuals
and to a larger population. Includes prevention and wellness programs as well as
other community health improvement services (screenings, health education, support
groups, and health fairs) supported by operational funds, grants, in- kind donations,
and philanthropy. Calculations based on cost less direct revenue. Direct offsetting
159
revenue includes any revenue generated by the activity or program, such as payment or
reimbursement for services provided to program patients. Direct offsetting revenue does
not include restricted or unrestricted grants or contributions that the organization uses
to provide community benefit.
• Community Benefit Operations – Includes costs associated with planning and
operating community benefit programs. Such as community health needs assessments
and administration.
• Subsidized Health Services – Patient care services the organization provides despite
a financial loss, (even) after removing the effects of charity care and Medi-Cal shortfalls
(and bad debt). Clinical programs provided at a loss because they are needed by the
community. The service meets an identified community need if it is reasonable to
conclude that if the organization no longer offered the service, the service would be
unavailable in the community, the community’s capacity to provide the service would
be below the community’s need, or the service would become the responsibility of
government or another tax-exempt organization. Example of such services are; inpatient
psychiatric units, satellite clinics serving low-income communities, and burn units.
• Cash and In-Kind Contributions – Contributions made by the organization to health
care organizations and other community groups that are restricted to one or more
community benefit activities. In-kind contributions include the cost of hours donated
by staff to the community while on the organization’s payroll, indirect cost of space
donated to tax-exempt companies (such as for meetings), and the financial value
(generally measured at cost) of donated food, equipment, and supplies.
• Community Building Activities – Programs that address underlying causes of health
problems in order to improve health status and quality of life. They focus on the
root causes of health problems, such as poverty, homelessness, and environmental
problems but do not provide medical care. Examples of community building per
the Schedule H are housing improvements, economic development, community
support, environmental improvements, leadership development, coalition building,
community health improvement advocacy, and workforce development. These activities
support community assets by offering the expertise and resources of the health care
organization. According to the IRS Community Building Activities do not count as
Community Benefits under the new Schedule H 990 but are still reportable outside the
community benefit table.
160
• Professional Education and Health Research – Includes clinical research as well as
professional education on non-Scripps employees including graduate medical education
(GME), nursing resource development, and other health care professional training. Costs
for medical residents and interns may be included as health professions educations costs.
Calculations based on total program expense.
• Payer – Insurance companies, health care service plans, Medicare, Medi-Cal, and other
private or public entities that pay hospitals for health care provided to their sponsored
patients.
Health Research – Health related research, such as studies and papers on alternative health care
delivery methods, testing of medical equipment, and controlled studies of therapeutic protocols.
Includes studies that are self funded or receive funding from a tax- exempt government entity and
have a goal of generating knowledge that is made available to the public.
Under-Reimbursed Care – Care that is reimbursed below cost by CMS (County Medical Services),
Medi-Cal and Medi-Cal HMO, Medicare, Medicare PPO, Medicare HMO, and SHPS Medicare.
Volunteer Hours – Includes the labor hours contributed by Scripps employees and affiliated
physicians in support of Scripps sponsored activities for which no compensation is received.
The dollar value is not included in Scripps’ “community benefit contribution.”
161
Appendix B – Scripps Uncompensated Care FY10 Methodology
Scripps continues to contribute resources to provide low and no-cost health care services to
populations in need. During FY10, Scripps contributed $286,232,394 to uncompensated health
care, including, $43,419,911 in charity care, $228,123,400 in Medi-Cal and Other Means Tested
Government Programs and Medicare shortfall, and $14,689,084 in bad debt.
Schedule H Methodology
Schedule H requires the uncompensated care to be divided into four categories: Charity care,
under-reimbursed Medi-Cal and Other Means Tested Government Programs, Bad Debt, and
under-reimbursed Medicare. Bad debt and Medicare shortfalls are reportable under the Schedule
H guidelines but do not count towards the community benefit totals. Thus, the categories are
reported in a specific order/hierarchy. Charity Care and under-reimbursed Medi-Cal and Other
Means Tested Government Programs are counted first.
Charity Care Methodology
The uncompensated cost is estimated by applying ratio-cost-to-charge (RCC) percentages for the
hospital to the gross charity adjustments. The following costs are excluded: Community health
services, professional education and research, and expenses excluded in the Medicare cost report.
Medi-Cal and Other Means Tested Government Programs–Hospitals
The shortfall is derived by computing operating margin at the patient level and summarizing the
patients with Medicare, Medicare PPO, Medicare HMO, Medi-Cal, Medi-Cal HMO, and CMS
primary insurance carriers. Operating margin is defined as net revenue less all variable, fixed, and
overhead costs. Profitability is estimated as follows: Net revenue is equivalent to payments plus
an estimation of the account balance for all open accounts, plus revenue from uncompensated
care pools including Medi-Cal DSH. Cost is derived using the relative value allocation methodology
per the Trendstar Cost Accounting system. The following costs are excluded: Charity adjustments
at cost for Medi-Cal and CMS patients, community health services, professional education and
research, and expenses excluded in the Medicare cost report.
Bad Debt Methodology
The uncompensated cost is estimated by applying ratio-cost-to-charge (RCC) percentages for the
hospital to the gross bad debt adjustments less recoveries. The following costs are excluded:
Bad debt adjustments at cost for Medi-Cal and CMS patients, community health services,
professional education and research, and expenses excluded in the Medicare cost report.
162
Medicare and Medicare HMO-Hospitals
The shortfall is derived by computing operating margin at the patient level and summarizing the
patients with Medicare and Medicare Senior primary insurance carriers. Operating margin is defined
as net revenue less all variable, fixed, and overhead costs. Profitability is estimated as follows: net
revenue is equivalent to payments plus an estimation of the account balance for all open accounts,
plus other revenue including IME and DSH. Cost is derived using the relative value allocation
methodology per the Trendstar cost accounting system. The following costs are excluded:
Charity and bad debt adjustments at cost for Medicare and Medicare Senior patients, community
health services, professional education and research, subsidized health services provided to
Medicare patients, and expenses excluded in the Medicare cost report.
Shortfall Methodology–Clinics
The shortfall was derived by extracting the Medicare, Medicare PPO, Medicare HMO, and Medicare
Capitated program, gross charges and net revenue from the patient billing system. The cost was
estimated by applying the ratio-cost-to-charges for Scripps Clinic and Scripps Coastal Medical
Centers to the gross charges. Shortfall is equal to Net Revenue less estimated cost using RCC
methodology.
163
Appendix C: Organizational Chart
Board of Trustees
Physician Physician
Leadership
CEO Business Leader
Cabinet C. Van Gorder Cabinet
Financial
Legal
Scripps Medical Services,
Services, SMH La Jolla SMH Encinitas Scripps Green Scripps Mercy Home Health
(San Diego & Chula Vista) Foundation Facilities
Quality G. Fybel C. Etter R. Brown M.L Carraher
T. Gammiere L. Harrison &
R. Sheridan
Construction
Medical R. Rothberger
Management Human
Scripps Clinic
& Physician Resources,
Co-Mgmt, Performance
Research, Management,
Scripps Scripps Coastal Innovation
Whittier Medical Center V. Buzachero
Diabetes
Institute Strategic
B. Eastman, MD Scripps Planning &
Cardiovascular Business
Scripps Health and Thoracic Development,
Foundation Surgery Group Information
J. Engle Services
J. Komar
Audit
&
Compliance
Scripps Health Reporting Structure
G. Mueller
11/15/2010
164
Appendix D: Scripps in Your Neighborhood
LEGEND
Oceanside
Scripps Hospital Campuses
18 Vista A Scripps Memorial Hospital Encinitas
19 20 21
78 16 B Scripps Green Hospital
22 • Scripps Center for Integrative Medicine
El C
Escondido • Scripps Translational Science Institute
11 • Scripps Clinical Research Center
am
Carlsbad • Scripps Cardiovascular and
ino
Thoracic Surgery Group
15
Real
5 C Scripps Memorial Hospital La Jolla
14 • Scripps McDonald Center
Encinitas • Scripps Whittier Diabetes Institute
15 • Scripps Center for Executive Health
• Scripps Polster Breast Care Center
A 25 • Scripps Mericos Eye Institute
4 Rancho • Scripps Cardiovascular and
Bernardo Thoracic Surgery Group
Del Mar
7 D Scripps Mercy Hospital – San Diego
12
3 56
• Mercy Clinic
1 • Scripps Mercy Surgery Pavilion
• Scripps Cardiovascular and
Carmel Valley Thoracic Surgery Group
E Scripps Mercy Hospital – Chula Vista
Scripps Clinic
1 Carmel Valley (Lab onsite)
2 Coronado (Division of Dermatology)
B 3 Del Mar (Center for Weight Management)
10 Santee 67 4 Encinitas (Lab onsite)
C 5
5 La Jolla (Division of OB-GYN)
26 52 125
6 Mission Valley (Lab onsite)
805 163 7 Rancho Bernardo (Urgent Care & Lab onsite)
27 9 8 Rancho San Diego (Lab onsite)
La Jolla 9 Santee (Lab onsite)
La Mesa 10 Torrey Pines (Urgent Care & Lab onsite)
6 8 Scripps Coastal Medical Center
11 Carlsbad (Lab onsite)
8 163 24 12 Del Mar (Lab onsite)
D 8 13 Eastlake (Lab onsite)
14 Encinitas (Lab onsite)
17 94 94
San Diego 15 Encinitas (OB-GYN only)
16 Escondido (Lab onsite)
125 17 Hillcrest (Lab onsite)
13 18 Oceanside (Lab onsite)
Coronado 54 19 Oceanside (Rehab only)
2 20 Vista (Urgent Care & Lab onsite)
Eastlake
21 Vista (OB-GYN only)
23 22 Vista (Rheumatology & Physical Medicine only)
Chula Vista Well Being Centers
E 23 Chula Vista
24 City Heights
25 Encinitas
805 26 La Jolla
5 Other Locations
27 Scripps Home Health Care
Call 1-800-SCRIPPS orMEXICO
visit scripps.org for more information
165
Appendix E: San Diego County HHSA Geographic Services Regions
CENTRAL SOUTH NORTH INLAND
• Central San Diego • Chula Vista • Borrego Springs
• Mid City • Coronado • Escondido
• Southeast San Diego • National City • Fallbrook
• South Bay • North San Diego
NORTH CENTRAL • Sweetwater • Palomar/Julian
• Coastal • Pauma
• Elliott Navajo EAST • Poway
• Kearny Mesa • Alpine • Ramona
• Mira Mesa • El Cajon • San Marcos
• Miramar • Harbison Crest • Valley Center
• Peninsula • Jamul
• University • La Mesa
• Laguna/Pine Valley
NORTH COASTAL • Lakeside
• Carlsbad • Lemon Grove
• Del Mar • Mountain Empire
• Oceanside • Santee
• Pendleton • Spring Valley
• San Dieguito
• Vista
Note: These regions have been designated by the County of San Diego Health and Human Services Agency (HHSA) for the purpose
of service delivery. The regions include different sub-regional area (SRA) groupings than the regions designated by the San Diego
Association of Governments (SANDAG).
166
For more information about the programs and services
offered by Scripps Health, visit www.scripps.org/communitybenefit or
contact the Office of Community Benefit Services at 858-678-7095.